Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey

RESEARCH ARTICLE Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey Jördis M. Zill*, Isabelle Scholl, Martin Härter, Jörg Dirmaier Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany * Abstract Background OPEN ACCESS Citation: Zill JM, Scholl I, Härter M, Dirmaier J (2015) Which Dimensions of Patient-Centeredness Matter? Results of a Web-Based Expert Delphi Survey. PLoS ONE 10(11): e0141978. doi:10.1371/journal. pone.0141978 Editor: Wen-Chih Hank Wu, Providence VA Medical Center and Brown University, UNITED STATES Received: February 26, 2015 Present models and definitions of patient-centeredness revealed a lack of conceptual clarity. Based on a prior systematic literature review, we developed an integrative model with 15 dimensions of patient-centeredness. The aims of this study were to 1) validate, and 2) prioritize these dimensions. Method A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1) give an individual rating on a nine-pointscale on relevance and clarity of the dimensions, 2) add missing dimensions, and 3) prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median < 7 on one of the criteria. Accepted: October 15, 2015 Published: November 5, 2015 Results Copyright: © 2015 Zill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 105 experts participated in round one and 71 in round two. In round one, one new dimension was suggested and included for discussion in round two. In round two, this dimension did not reach sufficient ratings to be included in the model. Eleven dimensions reached a median  7 on both criteria (relevance and clarity). Four dimensions had a median < 7 on one or both criteria. The five dimensions rated as most important were: patient as a unique person, patient involvement in care, patient information, clinician-patient communication and patient empowerment. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This project is funded by the German Federal Ministry of Education and Research (project number: 01GX1043). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Discussion 11 out of the 15 dimensions have been validated through experts’ ratings. Further research on the four dimensions that received insufficient ratings is recommended. The priority order of the dimensions can help researchers and clinicians to focus on the most important dimensions of patient-centeredness. Overall, the model provides a useful framework that can be PLOS ONE | DOI:10.1371/journal.pone.0141978 November 5, 2015 1 / 15 Results of an Expert Delphi Survey on Patient-Centeredness used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy. Background Introduction Patient-centeredness is an internationally widely discussed topic in high-quality health care and modern medicine [1–5]. Moreover, there is an increased recognition of the concept at the health policy level. Already in 2001, the US Institute of Medicine’s (IOM) publication “Crossing the Quality Chasm: A New Health System for the 21st Century” declared patient-centeredness to be one of six goals for health care improvement of the US health care system [6, 7]. In 2003, Health Canada highlighted the essential meaning of patient-centeredness in health care by creating the initiative Interdisciplinary Education for Collaborative Patient-Centered Practice (IECPCP) [8]. In Australia, patient-centered care is supported by the Australian Charter of Healthcare Rights, which ensures the provision of safe and high-quality care and by the National Safety and Quality Framework for health care, which was developed in 2009 to improve the healthcare system [9]. In the UK, patient-centeredness is a core concept in professional medical guidance [10]. In Germany, a large research priority program on patient-centeredness and chronic diseases was launched from the government in 2007, including a total funding volume of over 20 million Euro allocated to 77 research projects (www.researchpatientcenteredcare.org). Despite a large amount of research addressing patient-centeredness, no global consensus regarding its definition and conceptualization has been established yet. Van Dulmen [11] states that it is a “fuzzy concept”, which lead to more confusion than clarity. Moreover, Epstein and colleagues [12] outline it as a “multifaceted construct, like intelligence”, and Hobbs [13] describes patient-centeredness as a “poorly conceptualized phenomenon”. Similar results about the ambiguity of the German term for patient-centeredness were found in a pilot study of this project [14]. Accordingly, existing definitions of the term differ considerably. Gerteis et al. [15] identified seven domains of patient-centered care (e.g. respect for patients’ values, preferences, and needs; co-ordination and integration of care). The dimensions of Gerteis et al. were adopted by the Picker Institute in 2004 and have been used since then to evaluate patient-centeredness in the US and Europe [16]. The IOM defined the concept as “care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patients’ values guide all clinical decisions” [6]. Stewart et al. postulated six interactive elements of the patient-centered method (e.g. exploring both the disease and the illness experience, understanding the whole person) [17, 18]. Epstein [12] described patient-centered communication in four domains of (e.g., eliciting and understanding the patient’s perspective and concerns, helping patients to share power and responsibility). Another widely cited concept was developed by Mead and Bower, who derived five key dimensions of patient-centeredness from a literature review (e.g. sharing power and responsibility, therapeutic alliance) [19, 20]. Some recent research concentrated on the benefits of patient-centered care. For instance, a systematic review of over 40 studies conducted by Rathert et al. (2012) examined the relationship between dimensions of patient-centered care and patient satisfaction, patient clinical and organizational outcomes [21]. Overall, the review showed that patient-centeredness had positive effects on these outcomes. Nevertheless, since definitions and therefore m (...truncated)