A nationwide participatory programme to measure person-centred hospital care in Italy: Results and implications for continuous improvement

Development of patient-centred care in acute hospital settings: A meta-narrative review

BACKGROUND

Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context.

AIM

To understand the development of patient-centred care in the context of acute hospital settings over the past decade.

METHODS

A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic.

RESULTS

One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care.

CONCLUSIONS

Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions.

TWEETABLE ABSTRACT

Patient-centred care in acute care settings - we have arrived! Is it sustainable?

Where are we in shared decision-making in Italy? A brief updated review

The aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient involvement in health care in Italy, by updating the previous versions of the review. In the past 5 years some progress has been made towards a higher involvement of patients in their health care and patient-centredness into the national health care system. The updated scoping literature search focused on articles reporting primary data collected in Italy and showed a great increase in the number of publications. Nonetheless, the research efforts are still relatively sporadic compared to other countries especially as for evaluations of interventions and, most notably, they are not driven by a consistent effort to promote SDM and PCC in clinical practice.