Challenges of research on person-centered care in general practice: a scoping review

Jako Burgers, Trudy Van Der Weijden, Erik Bischoff

Keywords: General Practice, Family Practice, Patient-Centered Care, Patient Outcome Assessment, Scoping review

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.

Research questions:
What are the concepts and definitions, the type of interventions, and the outcome measures used in research on person-centered care in general practice?

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.

Four systematic reviews were 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.

Person-centered care is a concept that seems obvious and understandable in real life but is complex to operationalise in research. This scoping review reinforces the need to use of mixed qualitative and quantitative methods in general practice research. Research could be personalised 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.

Points for discussion:
The use of classic designs as randomized controlled trials may not be optimal for studying the effects of person-centered care on patient outcomes.

Research methods used in implementation and complexity science, and ‘individual point-of-care trials’ building on the framework of N-of-1 studies can be considered.

Beyond the evidence, the worldwide consensus on person-centered care as core value in general practice will not be affected.