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Loughlin M. Inspecting the links: Knowledge, evidence and value in healthcare. J Eval Clin Pract 2024; 30:729-734. [PMID: 39083553 DOI: 10.1111/jep.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
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de Miranda L, Loughlin M. Philosophical health: Unveiling the patient's personal philosophy with a person-centred method of dialogue. J Eval Clin Pract 2023; 29:1161-1170. [PMID: 37232228 DOI: 10.1111/jep.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
Grounded in ideas about sense-making and whole-person care with a long intellectual heritage, the movement for Philosophical Health-with its specific conceptions of philosophical care and counselling-is a relatively recent addition to the ongoing debate about understanding better the perspectives of patients to improve health practice. This article locates the development of this movement within the context of broader discussions of person-centred care (PCC), arguing that the approach advocated by defenders of philosophical health can provide a straightforward method for implementing PCC in actual cases. This claim is explained and defended with reference to the SMILE_PH method created by Luis de Miranda (Sense-Making Interviews Looking at Elements of Philosophical Health), an approach recently trialled convincingly with people living with traumatic spinal cord injury.
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Affiliation(s)
- Luis de Miranda
- Center for Medical Humanities, Uppsala University, Uppsala, Sweden
| | - Michael Loughlin
- School of Biomedical Sciences, University of West London, London, UK
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Loughlin M, de Miranda L. Editorial for the 2023 philosophy thematic edition: Treating the whole person: Philosophical health. J Eval Clin Pract 2023; 29:1057-1060. [PMID: 37583122 DOI: 10.1111/jep.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Michael Loughlin
- School of Biomedical Sciences, University of West London, London, UK
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Loughlin M, Dolezal L, Hutchinson P, Subramani S, Milani R, Lafarge C. Philosophy and the clinic: Stigma, respect and shame. J Eval Clin Pract 2022; 28:705-710. [PMID: 36053567 PMCID: PMC9826409 DOI: 10.1111/jep.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the 'stigma-shame nexus'. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of 'deviancy' and 'looked-after children'. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence.
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Affiliation(s)
- Michael Loughlin
- Institute for Person-Centred Health and Social Care, School of Biomedical Sciences, University of West London, London, UK
| | - Luna Dolezal
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Phil Hutchinson
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Raffaella Milani
- School of Human and Social Sciences, University of West London, London, UK
| | - Caroline Lafarge
- School of Human and Social Sciences, University of West London, London, UK
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Burgers JS, van der Weijden T, Bischoff EWMA. Challenges of Research on Person-Centered Care in General Practice: A Scoping Review. Front Med (Lausanne) 2021; 8:669491. [PMID: 34249968 PMCID: PMC8264253 DOI: 10.3389/fmed.2021.669491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Delivering person-centered care is one of the core values in general practice. Due to the complexity and multifaceted character of person-centered care, the effects of person-centered care cannot be easily underpinned with robust scientific evidence. In this scoping review we provide an overview of research on effects of person-centered care, exploring the concepts and definitions used, the type of interventions studied, the selected outcome measures, and its strengths and limitations. Methods: Systematic reviews on person-centered care compared to usual care were included from Pubmed, Embase, and PsycINFO. The search was conducted in February 2021. Data selection and charting was done by two reviewers. Results: The literature search yielded 481 articles. A total of 21 full-text articles were assessed for eligibility for inclusion. Four systematic reviews, published between 2012 and 2018, were finally included in this review. All reviews used different definitions and models and classified the interventions differently. The explicit distinction between interventions for providers and patients was made in two systematic reviews. The classification of outcomes also showed large differences, except patient satisfaction that was shared. All reviews described the results narratively. One review also pooled the results on some outcome measures. Most studies included in the reviews showed positive effects, in particular on process outcomes. Mixed results were found on patient satisfaction and clinical or health outcomes. All review authors acknowledged limitations due to lack of uniform definitions, and heterogeneity of interventions and outcomes measures. Discussion: Person-centered care is a concept that seems obvious and understandable in real life but is complex to operationalize in research. This scoping review reinforces the need to use mixed qualitative and quantitative methods in general practice research. For spreading and scaling up person-centered care, an implementation or complexity science approach could be used. Research could be personalized by defining therapeutic goals, interventions, and outcome variables based on individual preferences, goals, and values and not only on clinical and biological characteristics. Observational data and patient satisfaction surveys could be used to support quality improvement. Integrating research, education, and practice could strengthen the profession, building on the fundament of shared core values.
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Affiliation(s)
- Jako S. Burgers
- Dutch College of General Practitioners, Utrecht, Netherlands
- Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Trudy van der Weijden
- Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Erik W. M. A. Bischoff
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
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Loughlin M, Buetow S, Cournoyea M, Copeland SM, Chin-Yee B, Fulford KWM. [Not Available]. J Eval Clin Pract 2019; 25:911-920. [PMID: 31733025 DOI: 10.1111/jep.13297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022]
Abstract
There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as "ethical add-ons" but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that "sits within the minds" of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to 'integrate' different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts.
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Affiliation(s)
- Michael Loughlin
- European Institute for Person-Centred Health and Social Care, University of West London, London, UK
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Michael Cournoyea
- Institute for the History and Philosophy of Science, University of Toronto, Toronto, Canada
| | - Samantha Marie Copeland
- Ethics and Philosophy of Technology Section, Department of Values, Technology and Innovation, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | | | - K W M Fulford
- Collaborating Centre for Values Based Practice, University of Oxford, Oxford, UK
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Moynihan R, Brodersen J, Heath I, Johansson M, Kuehlein T, Minué-Lorenzo S, Petursson H, Pizzanelli M, Reventlow S, Sigurdsson J, Stavdal A, Treadwell J, Glasziou P. Reforming disease definitions: a new primary care led, people-centred approach. BMJ Evid Based Med 2019; 24:170-173. [PMID: 30962252 DOI: 10.1136/bmjebm-2018-111148] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ray Moynihan
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | | | - Iona Heath
- Royal College of General Practitioners, London, UK
| | | | | | | | | | | | | | | | | | | | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (crebp.net.au), Robina, Queensland, Australia
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Thomas Y, Seedhouse D, Peutherer V, Loughlin M. An empirical investigation into the role of values in occupational therapy decision-making. Br J Occup Ther 2019. [DOI: 10.1177/0308022619829722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction The importance of values in occupational therapy is generally agreed; however, there is no consensus about their nature or their influence on practice. It is widely assumed that occupational therapists hold and act on a body of shared values, yet there is a lack of evidence to support this. Method The research tested the hypothesis that occupational therapists’ responses to ethically challenging situations would reveal common values specific to the occupational therapy profession. A total of 156 occupational therapists were asked to decide what should be done in five common-place yet ethically complex situations, presented as scenarios for debate. Results The results show that while most occupational therapists share very general values, they frequently disagree about what to do in practice situations, often justifying their choices with different and sometimes conflicting specific values. In some cases, the same respondents espouse contradictory values in similar situations. Conclusion The extensive literature about decision-making – together with the study’s results – confirm that when occupational therapists make decisions, they draw on multiple factors, consciously and unconsciously. These factors vary between individuals. Value judgements are one part only of a complex process which includes personal experience, intuition, social influences, culture, psychological influences and relationships with both colleagues and clients.
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Affiliation(s)
- Yvonne Thomas
- School of Allied Health and Community, University of Worcester, UK
- James Cook University, Australia
| | - David Seedhouse
- University of Derby, UK
- University of Western Sydney, Australia
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Andersen F, Anjum RL, Rocca E. Philosophical bias is the one bias that science cannot avoid. eLife 2019; 8:e44929. [PMID: 30864947 PMCID: PMC6415937 DOI: 10.7554/elife.44929] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 01/17/2023] Open
Abstract
Scientists seek to eliminate all forms of bias from their research. However, all scientists also make assumptions of a non-empirical nature about topics such as causality, determinism and reductionism when conducting research. Here, we argue that since these 'philosophical biases' cannot be avoided, they need to be debated critically by scientists and philosophers of science.
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Affiliation(s)
- Fredrik Andersen
- NMBU Centre for Applied Philosophy of Science, School of Economics and BusinessNorwegian University of Life SciencesAasNorway
- Faculty of Health and WelfareØstfold University CollegeHaldenNorway
| | - Rani Lill Anjum
- NMBU Centre for Applied Philosophy of Science, School of Economics and BusinessNorwegian University of Life SciencesAasNorway
| | - Elena Rocca
- NMBU Centre for Applied Philosophy of Science, School of Economics and BusinessNorwegian University of Life SciencesAasNorway
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Anjum RL, Copeland S, Kerry R, Rocca E. The guidelines challenge-Philosophy, practice, policy. J Eval Clin Pract 2018; 24:1120-1126. [PMID: 30027569 DOI: 10.1111/jep.13004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Rani Lill Anjum
- Principal Investigator CauseHealth Project, Director Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
| | - Samantha Copeland
- CauseHealth Project, Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
| | - Roger Kerry
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Elena Rocca
- CauseHealth Project, Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
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