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Patient Centred Approach to Care

Original Editor - Ewa Jaraczewska based on the course by Marissa Fourie

Top Contributors - Ewa Jaraczewska and Jess Bell

Introduction

Patient-centred care is well-established as an essential element of high-quality patient care.[1][2] Recognised by the World Health Organization (WHO) as a fundamental aim of Health 2020, it focuses on the partnership between patients and healthcare professionals to achieve increased patient satisfaction and improved outcomes.[3]

Defining Patient-Centred Care

Patient-centred care represents a healthcare delivery model aligned with individual patients' values, needs, and preferences.[4]

Patient-centred care is achieved when clinicians actively engage patients in healthcare discussions and decision-making.[4][5] Clinicians who embrace a patient-centred perspective take time to consider what is known about the patient and understand them as a unique person before forming a clinical diagnosis. This approach allows for more personalised and effective care planning.[4]

The clinician-patient partnership is key in patient-centred care. It helps transform patients from passive recipients of healthcare into active participants who play a meaningful role in managing their health and well-being.[4]

[6]

Patient-Centred Care vs Person-Centred Care

The concept of person-centred care has emerged from patient-centred care. Both patient-centred and person-centred care prioritise the active involvement of the patient in their healthcare. However, patient-centred care emphasises achieving a functional life, while person-centred care focuses on the patient's experience, well-being, and a meaningful life.[7] Both approaches are valuable in medical intervention, and the specific needs and desired outcomes of each patient will determine which model should be given more emphasis in their management.[4]

The following example illustrates the difference between patient-centred and person-centred care.[4]

81-year old Mr Xi sustained a femur fracture and is unable to mobilise independently. He is currently mobilising exclusively in a wheelchair and is unable to easily leave his apartment. Prior to his injury, he used to garden and enjoyed meeting his friend for tea every other day. The functional limitations caused by his change in mobility is isolating him and he feels rather depressed.

A patient-centred approach would prioritise improving Mr. Xi's mobility to enhance his ability to perform functional activities, such as attending social gatherings and gardening. Treatment might include arranging for a caregiver to assist Mr. Xi with mobility or for a physiotherapist to help rehabilitate his gait using an assistive device.

A person-centred approach would focus on Mr. Xi's need for social interaction and engagement in hobbies like gardening, seeking alternative ways to meet these needs. Occupational therapy could explore individualised options for social interaction, such as arranging visitors or using phone / video calls, and finding alternative recreational activities.

Benefits of the Patient-Centred Approach

The patient-centred approach has many benefits. Its focus on collaboration improves satisfaction as patients feel more valued and understood within the therapeutic relationship.[4] It enables patients to actively engage in their own care, reduces symptom burden and, ultimately, can improve clinical outcomes and quality of life.[8][9][2]

Key Principles of the Patient-Centred Approach

There are several interconnected principles in patient-centred care: (1) exploring health, disease, and the illness experience, (2) understanding the whole person and their context, (3) finding common ground and (4) enhancing the patient-clinician relationship.[4]

Exploring Health, Disease and the Illness Experience

In the patient-centred approach, clinicians must aim to understand the meaning and impact of health, disease and illness on a person. This exploration serves two purposes:[4]

  • it helps clinicians understand the patient's experience
  • it guides the focus of the management plan

They must also understand the key differences between health, disease and illness.

Health "is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".[10] For some, health might mean freedom from specific symptoms. For others, it might be the ability to exercise at a particular intensity or complete certain activities. To establish and manage expectations and create appropriate care plans, clinicians must understand each patient's definition and perception of health.[4][11]

Disease occurs when there is a deviation from the normal human condition because of pathology.[4] Disease refers to an objective medical condition, such as a cerebrovascular accident or pneumonia.[11]

Illness is "a feeling, an experience of unhealth which is entirely personal, interior to the person".[12] Illness is the manifestation of disease, such as disability following a stroke or fatigue, shortness of breath and fever accompanying pneumonia.[11] Illness is more than physical symptoms. It includes a person's feelings and ideas, functional limitations, and expectations for recovery or management. By understanding these dimensions, and approaching a patient's illness experience with empathy,[13] healthcare providers can develop patient-centred approaches that address the medical condition and its impact on an individual's life.[4]

Understanding the Whole Person and Their Context

Terms like "the whole person", "holistic", and "biopsychosocial" are often used interchangeably in healthcare literature.[14] Each term emphasises the need to acknowledge and address multiple dimensions when working with patients, including biological, psychological, and social factors, as well as the patient's environmental context or spirituality.[14]

The patient-centred approach recognises each person as unique. It considers their lived experience and places them at the centre of healthcare delivery.[15] To fully understand a patient, clinicians must explore multiple aspects of their lives, including their life history, personal and developmental issues, individual values, morals, ideas, motivations, and preferences. Additionally, gaining insight into family dynamics or support systems, employment situation, cultural background, community connections, and overall ecosystem helps the clinician understand the patient's broader context. Often, clinicians can gather this information through careful observation and general interactions with the patient during regular care encounters, rather than through specific questioning.[4]

By understanding the whole person, clinicians are better able to create tailored care plans that meet the patient's unique needs and preferences.[4]

Finding Common Ground

In patient-centred care, finding common ground with a patient helps prevent a potential misalignment between patient and practitioner expectations.[4]

When patients seek rehabilitation services, they have very specific, personal needs and goals. They often want to improve their quality of life and daily functioning. They may wish to reduce pain, improve mobility, and regain the ability to participate in activities that matter to them. Healthcare professionals have their own goals - they aim to identify and address underlying pathology, through accurate assessment and by implementing evidence-based interventions.[16] These perspectives are not in opposition, but they can result in different priorities. Finding common ground requires healthcare professionals to reach a mutual understanding with patients in three key areas.[16]

Firstly, they must define the problem together. The patient's interpretation of their condition and its impact on their life must be considered. A shared problem definition acknowledges both the clinical reality and the patient's experience.

Secondly, they must establish goals and priorities with the patient. These goals and priorities need to reflect the clinical situation and patient values. However, when there is a discrepancy between goals, the clinician must thoughtfully negotiate with the patient, rather than simply imposing their professional priorities.

Thirdly, they must clearly delineate each person's roles and responsibilities. A patient-clinician relationship should function as a partnership with defined contributions from each party. Patients need to understand their active role in the recovery process, while clinicians must recognise the boundaries of their influence.

The goal is to support a patient to make informed decisions that respect clinical wisdom and personal values. Sometimes, this means accepting that the patient's priorities may differ from the healthcare provider's choice while ensuring the patient understands the potential consequences of all options.

Enhancing the Patient-Clinician Relationship

The relationship between patient and clinician influences treatment adherence, patient satisfaction, and clinical outcomes.[16]

The patient-clinician relationship must be built on fundamental human values: dignity, kindness, compassion, courtesy, respect, understanding, and honesty. These qualities are essential components of the healing process.[4] When patients genuinely feel seen and valued, they become more engaged in their care. By developing connections intended to last, a healthcare practitioner creates a safe space where patients feel comfortable sharing concerns, asking questions, and participating in decision-making. This long-term perspective allows for care that evolves with the patient's changing needs and circumstances.

In patient-centred practice, clinicians consciously work to redistribute this power and foster self-efficacy by recognising the patient's expertise in their own lived experience.[16]

To make the patient-clinician relationship effective, the healthcare provider should engage in ongoing self-reflection to ensure they are aware of their biases, assumptions, and emotional responses, which might interfere with patient care. They must adapt their approach based on each patient's needs - some patients may value direct, detailed information while others prefer broader explanations. They should also maintain connection and understanding with their patients in times of vulnerability while creating conditions for effective treatment.

Enhancing Patient-Centred Care

Various factors, such as communication, shared decision making, empathy, and cultural competence, can facilitate the patient-centred approach.

Communication

Communication in healthcare is defined as the exchange of information between a patient and a clinician, and this will include the family or caretakers where applicable.[4]

In patient-centred care, communication is a therapeutic tool that can significantly influence health outcomes. Patient-centred communication transforms clinical encounters into meaningful exchanges that honour each patient's unique circumstances, beliefs, and concerns.[17] Patient-centred communication creates the foundation upon which diagnosis, treatment planning, and ongoing care are built.[17]

Poor communication can have negative consequences. It can lead to increased patient dissatisfaction and a fracturing of care continuity. Patient safety can be compromised, and patient autonomy diminishes. Inadequate communication undermines the shared decision-making process which is at the heart of patient-centred practice.

Effective, meaningful communication emerges from the genuine "bond" between patient and provider. This understanding develops gradually, often requiring multiple encounters to establish the trust necessary for open dialogue. Taking the time to build these relationships improves communication quality and health outcomes.[18]

There are many benefits of patient-centred communication. When healthcare providers clearly present available care options and acknowledge the patient's right and ability to choose from these options, patients are empowered to make meaningful choices about their care. Patient-centred communication supports patients when they make decisions and implement their chosen action. It also helps patients gain greater control of their healthcare journey. At each stage, they can make informed decisions that align with their values and preferences.[17]

Obtaining informed consent is a key component of patient-centred communication. Informed consent is when a patient or surrogate agrees or consents to a specific medical intervention. Informed consent can be interactive (a conversation) or non-interactive (reading and signing a document). When seeking informed consent, clinicians should provide information about the procedure, including any risks, benefits and alternatives. The patient should understand the information, be free to discuss it and consent voluntarily.[19]

Providing effective patient education is another key skill for healthcare professionals. Patient education is defined as educational activities that help patients manage their treatment, prevent complications, and maintain or improve their quality of life. Patient education can enhance autonomy and enable patients to become active partners in their healthcare.[20]

Healthcare professionals must also be able to navigate difficult conversations with patients. The Serious Illness Conversation Guide[21] provides a structure for these conversations:[4]

  • setting up the conversation: specific factors to consider in this step include the location, time, and who should be present
  • assessing illness understanding: this step encourages clinicians to explore the patient's knowledge and information preferences
  • sharing the prognosis: when discussing a prognosis, clinicians should tailor the information to the patient's preferences and allow time for processing
  • explore key topics: this includes goals, fears, worries, sources of strength, and social support
  • close the conversation: in this step, clinicians provide a summary of the discussion and recommendations, reiterate their support and commitment to the patient's decision
  • documentation

If you would like to learn more about enhancing communication through active listening, please see: Communication Skills.

Shared Decision Making

"Shared decision making (SDM) is a collaborative process that involves patients, physiotherapists, and clinicians making decisions regarding the patient’s health after discussing the available options; identifying the benefits and demerits of each option; and considering the patient’s values, preferences, and personal circumstances."[22]

Shared decision making ensures a collaborative approach to healthcare decisions. It recognises two equally valuable sources of expertise: the clinician's professional knowledge and the patient's lived experience. The clinician brings specialised training, clinical reasoning, and familiarity with evidence-based practices.[22] The patient contributes their expert knowledge of their body, personal values, life context, and treatment preferences. When these perspectives merge, decisions are more likely to be clinically sound and meaningful.

In shared decision making, neither party is solely responsible for a decision. Instead, this approach creates a middle path where responsibility is shared. Shared decision making follows a structured yet flexible process. Clinicians and patients work together to identify and clarify the problem. Defining the problem together ensures alignment in priorities from the outset. The clinician and patient then explore all feasible options, including the possibility of no intervention. The clinician presents various approaches and discusses the potential benefits and harms of each option. They must take care to use terms and language the patient understands. The patient is then free to ask questions and voice concerns. This open dialogue creates a space to address any misconceptions and ensures patients feel heard and respected. Finally, there must be confirmation that the clinician and patient have reached a mutual understanding about the chosen path forward. This explicit acknowledgement again helps prevent misalignment of expectations.[4]

In acute care settings, shared decision making might emphasise immediate clinical priorities while incorporating patient input on approach and preferences. In longer-term care settings, shared decision making often becomes more involved, with greater exploration of patient goals, values, and life circumstances.[18]

When successfully implemented, shared decision making can have numerous benefits, including:

  • increased patient confidence about their decisions and healthcare provider decisions
  • increased motivation to adhere to treatment plans
  • increased patient satisfaction
  • improved clinical outcomes

[23]

Empathy

Empathy is the ability to understand the patient’s situation, perspectives, and feelings; communicate that understanding and check its accuracy; and, then act on that understanding with the patient.[24]

Empathy provides a foundation for effective therapeutic relationships and drives positive healthcare experiences.[4] In healthcare, empathy is built upon three fundamental actions:[25]

  1. understanding the patient's perspective
  2. communicating this understanding effectively
  3. acting in response to the patient's needs

There are different types of empathy relevant to healthcare. Cognitive empathy refers to the clinician's cognitive understanding of a patient's context and emotional experience. Through reasoning and logic, healthcare providers are able to gain an understanding of the patient's situation and recognise emotions, such as anxiety or distress. Self-awareness and emotional regulation are also key components of cognitive empathy. Clinicians should be rationally aware that the patient's emotions and experiences belong to them and not the clinician.[4][26]

Affective empathy refers to a clinician's ability to relate to a patient's emotions and, to some degree, also feel this emotion in themselves. This connection allows clinicians to sense an emotion, such as patient uncertainty or apprehension. This can prompt further exploration of these feelings.[4][26]

We also have imaginative empathy. This refers to a clinician's ability to mentally step away from their own experience and take on the experience from the patient's perspective. In other words, the clinician can put themselves in their patient's shoes. Through imaginative empathy, healthcare providers are better able to see the world from their patient's context and perspective.[4][26]

Finally, we have behavioural empathy, which is a culmination of cognitive, affective, and imaginative empathy. Behavioural empathy helps us to translate understanding into helpful action. It represents the practical application of empathy in clinical practice.[4][26]

Empathy must be communicated to patients through verbal and nonverbal channels. Patients may respond to different communication styles, so healthcare providers must tailor their approach to individual patient profiles and preferences.[4]

Cultural Competence

Cultural competence is the ability to understand, appreciate, and interact with people from cultures or belief systems different from one's own.[4]

As healthcare systems serve increasingly diverse populations, the ability to understand, respect, and respond appropriately to cultural factors is an essential component of high-quality care.[27]

Various cultural factors can significantly influence patient experiences, autonomy, and decision-making processes and, thus, directly impact healthcare delivery. These factors include:[4]

  • health and illness beliefs specific to cultural backgrounds
  • culturally dictated gender roles
  • attitudes toward authority figures, including healthcare providers
  • the role of family and community in health decisions
  • communication styles and non-verbal communication patterns
  • religious and spiritual practices and their influence on healthcare choices
  • dietary preferences and restrictions

Understanding these factors enables healthcare providers to develop more effective and personalised therapeutic relationships with patients from diverse backgrounds.

Developing cultural competence is an ongoing process that involves several key elements, including (1) self-awareness, (2) acknowledging biases, (3) and acquiring cultural knowledge.

Self-awareness requires healthcare providers to recognise their cultural beliefs, values, attitudes, and practices. This awareness forms the foundation for understanding how their cultural perspective might differ from that of their patients.[28]

Clinicians must then identify and reflect on any biases they may hold. Recognising these biases is the first step toward mitigating their impact on patient care.[29]

While healthcare providers cannot be experts in all cultures, they should aim to acquire the cultural knowledge and skills necessary to navigate cultural diversity when providing care.[4][27]

Cultural sensitivity must be integrated into clinical practice and health promotion strategies. This integration has been shown to improve patient health outcomes across diverse populations.[5][30]

When healthcare providers develop cultural competence, they can establish stronger therapeutic relationships with patients, improve communication, increase patient satisfaction and engagement with treatment plans, reduce healthcare disparities among diverse populations and enhance overall quality of care.[31]

Resources

References

  1. ↑ World Health Organization.  Regional Office for Europe. Roadmap: strengthening people-centred health systems in the WHO European region: a framework for action towards coordinated/integrated health services delivery (CIHSD). Geneva: WHO; 2013.
  2. ↑ 2.0 2.1 Havana T, Kuha S, Laukka E, Kanste O. Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies. Scand J Caring Sci. 2023 Dec;37(4):1001-1015.
  3. ↑ Delaney LJ. Patient-centred care as an approach to improving health care in Australia. Collegian. 2018;25(1):119-23.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 Fourie M. Patent Centred Approach to Care Course. Plus, 2025.
  5. ↑ 5.0 5.1 Wasim A, Sajan M, Majid U. Patient-centered care frameworks, models and approaches: An environmental scan. Patient Experience Journal. 2023; 10(2):14-22.
  6. ↑ World Health Organization. WHO: What is people-centred care? Part 5 - An example of a Person Centred Care Decision. Available from: https://www.youtube.com/watch?pj-AvTOdk2Q [last accessed 4/3/2025]
  7. ↑ Håkansson Eklund J, Holmström IK, Kumlin T, Kaminsky E, Skoglund K, Höglander J, Sundler AJ, Condén E, Summer Meranius M. "Same same or different?" A review of reviews of person-centered and patient-centered care. Patient Educ Couns. 2019 Jan;102(1):3-11.
  8. ↑ Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013 Aug;70(4):351-79.
  9. ↑ Kayes NM, Papadimitriou C. Reflecting on challenges and opportunities for the practice of person-centred rehabilitation. Clin Rehabil. 2023 Aug;37(8):1026-1040.
  10. ↑ Health and Well-Being. World Health Organization. Geneva. Available from https://www.who.int/data/gho/data/major-themes/health-and-well-being#:~:text=The%20WHO%20constitution%20states%3A%20%22Health,of%20mental%20disorders%20or%20disabilities. [last access 26.02.2025]
  11. ↑ 11.0 11.1 11.2 Emson HE. Health, disease and illness: matters for definition. CMAJ. 1987 Apr 15;136(8):811-3.
  12. ↑ Marinker M. Why make people patients? J Med Ethics. 1975 Jul;1(2):81-4.
  13. ↑ Kato K. How can we understand illness? Phenomenology and the pillar of person-centred care. Br J Gen Pract. 2022 Mar 31;72(717):178-179.
  14. ↑ 14.0 14.1 Thomas H, Mitchell G, Rich J, Best M. Definition of whole person care in general practice in the English language literature: a systematic review. BMJ Open. 2018 Dec 14;8(12):e023758.
  15. ↑ Švab I, Cerovečki V. Person-centred care, a core concept of family medicine. Eur J Gen Pract. 2024 Dec;30(1):2393860.
  16. ↑ 16.0 16.1 16.2 16.3 Scambler S, Asimakopoulou K. A model of patient-centred care - turning good care into patient-centred care. Br Dent J. 2014 Sep;217(5):225-8.
  17. ↑ 17.0 17.1 17.2 Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021 Sep 3;20(1):158.
  18. ↑ 18.0 18.1 Roodbeen R, Vreke A, Boland G, Rademakers J, van den Muijsenbergh M, Noordman J, van Dulmen S. Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers. PLoS One. 2020 Jun 19;15(6):e0234926.
  19. ↑ Glaser J, Nouri S, Fernandez A, Sudore RL, Schillinger D, Klein-Fedyshin M, Schenker Y. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review. Med Decis Making. 2020 Feb;40(2):119-143.
  20. ↑ Ricci L, Villegente J, Loyal D, Ayav C, Kivits J, Rat AC. Tailored patient therapeutic educational interventions: A patient-centred communication model. Health Expect. 2022 Feb;25(1):276-289.
  21. ↑ Serious Illness Conversation Guide. Available from https://www.ariadnelabs.org/wp-content/uploads/2023/05/Serious-Illness-Conversation-Guide.2023-05-18.pdf (accessed 27 February 2025).
  22. ↑ 22.0 22.1 Alotaibi MA, Alhowimel AS, Alodaibi FA, Aloraifi M. The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions. J Multidiscip Healthc. 2023 Sep 8;16:2655-2665.
  23. ↑ The Health Foundation. What is Person Centred Care? Part 5 - An example of a Person Centred Care Decision. Available from: https://www.youtube.com/watch?pkgwnHDAopI [last accessed 4/3/2025]
  24. ↑ Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(Suppl):S9–S12.
  25. ↑ Tan L, Le MK, Yu CC, Liaw SY, Tierney T, Ho YY, Lim E, Lim D, Ng R, Ngeow C, Low J. Defining clinical empathy: a grounded theory approach from the perspective of healthcare workers and patients in a multicultural setting. BMJ Open. 2021 Sep 14;11(9):e045224.
  26. ↑ 26.0 26.1 26.2 26.3 Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S. The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel). 2020 Jan 30;8(1):26.
  27. ↑ 27.0 27.1 Stubbe DE. Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (Am Psychiatr Publ). 2020 Jan;18(1):49-51.
  28. ↑ Younas A. Self-awareness: A tool for providing culturally competent care. Nursing. 2020 Feb;50(2):61-63.
  29. ↑ Masters C, Robinson D, Faulkner S, Patterson E, McIlraith T, Ansari A. Addressing Biases in Patient Care with The 5Rs of Cultural Humility, a Clinician Coaching Tool. J Gen Intern Med. 2019 Apr;34(4):627-630.
  30. ↑ Brooks LA, Manias E, Bloomer MJ. Culturally sensitive communication in healthcare: A concept analysis. Collegian.2019;26(3):383-391.
  31. ↑ Hickson SV. Culturally competent healthcare. Clinics in Integrated Care. 2020;15:100130.
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