Learning from patients about patient-centredness: A realist review: BEME Guide No. 60

Background: Patient-centred work is an essential part of contemporary medicine. Literature shows that educational interventions contribute to developing patient-centredness, but there is a lack of insight into the associated learning processes. Objective: Through reviewing articles about educational interventions involving patients, we aspire to develop a program theory that describes the processes through which the educational interventions are expected to result in change. The processes will clarify contextual elements (called contexts) and mechanisms connected to learning patient-centredness. Methods: In our realist review, an initial, rough program theory was generated during the scoping phase, we searched for relevant articles in PubMed, PsycINFO, ERIC, CINAHL and Embase for all years before and through 2016. We included observational studies, case reports, interviews, and experimental studies in which the participants were students, residents, doctors, nurses or dentists. The relevance and rigour of the studies were taken into account during analysis. With deductive as well as inductive coding, we extended the rough program theory. Results: In our review, we classified five different contexts which affect how upcoming professionals learn patient-centredness. These aspects are influenced through components in the intervention(s) related to the learner, the teacher, and the patient. We placed the mechanisms together in four clusters – comparing and combining as well as broadening perspectives, developing narratives and engagement with patients, self-actualisation, and socialisation – to show how the development of (dimensions of) patient-centredness occurs. Three partial-program-theories (that together constituting a whole program theory) were developed, which show how different components of interventions within certain contexts will evoke mechanisms that contribute to patient-centredness. Translation into daily practice: These theories may help us better understand how the roles of patients, learners and teachers interact with contexts such as the kind of knowledge that is considered legitimate or insight in the whole illness trajectory. Our partial program theories open up potential areas for future research and interventions that may benefit learners, teachers, and patients.

背景：以患者为中心的工作是当代医学不可或缺的组成部分。文献表明，教育干预有助于培养以患者为中心的理念，但关于相关学习过程的理解尚显不足。目标：通过回顾涉及患者的教育干预文章，我们旨在构建一个程序理论，以描述教育干预预期导致变革的过程。该过程将阐明与学习以患者为中心相关的情境要素（称为情境）和机制。方法：在我们的现实主义综述中，在范围界定阶段生成了一个初步的、粗略的程序理论，我们通过 PubMed、PsycINFO、ERIC、CINAHL 和 Embase 检索了所有年份直至 2016 年的相关文章。我们纳入了观察性研究、病例报告、访谈和实验研究，其中参与者为学生、住院医生、医生、护士或牙医。在分析过程中，我们考虑了研究的关联性和严谨性。通过演绎和归纳编码，我们扩展了粗略的程序理论。结果：在我们的综述中，我们识别了五种不同的情境，这些情境影响着即将到来的专业人士学习以患者为中心的方法。这些方面受到干预措施（与学习者、教师和患者相关的部分）中组件的影响。我们将机制归纳为四个集群——比较与结合以及拓宽视野、发展叙事与患者互动、自我实现和社会化——以展示（以患者为中心的）维度的形成过程。我们开发了三个部分程序理论（共同构成一个完整的程序理论），展示了在特定情境下干预措施的不同组成部分如何引发有助于患者中心的机制。实践转化：这些理论有助于我们更好地理解患者、学习者、教师与诸如何种知识被视为合法或对整个疾病轨迹的洞察等情境之间的相互作用。我们的部分程序理论为未来的研究及可能惠及学习者、教师和患者的干预措施开辟了潜在领域。