Defining and measuring patient-centred care: an example from a mixed-methods systematic review of the stroke literature

Background Involving patients in the determination of their care is increasingly important, and health-care professionals worldwide have recognized a need for clinical outcome measures and interventions that facilitate patient-centred care delivery in a range of settings. Aim A mixed-methods review was conducted, which aimed to identify stroke-specific patient-centred outcome measures and patient-centred interventions. Search strategy Databases searched included MEDLINE and PsycINFO; search strings were based on MeSH terms and keywords associated with the terms stroke and patient-centred. Data extraction and analysis Descriptive statistics were used to report quantitative data; thematic analysis was also performed in the included studies. Main Results Three patient-centred outcome measures (Subjective Index of Physical and Social Outcomes, Stroke Impact Scale, Communication Outcome after Stroke scale) and four interventions were identified. Key elements of intervention design included delivery in peoples own homes, involvement of families and tailoring to individual needs and priorities. Thematic analysis enabled description of three broad themes: meaningfulness and relevance, quality, and communication, which informed the development of a definition of patient-centred care specific to the specialty of stroke. Conclusions It is important for health-care professionals to ensure that their practice is relevant to patients and families. The review identified three stroke-specific patient-centred outcome measures, key elements of patient-centred interventions, and informed the development of a definition of patient-centred care. These review-derived outputs represent a useful starting point for health-care professionals, whatever their specialty, who are working to reconcile tensions between priorities of health-care professionals and those of patients and their families, to ensure delivery of patient-centred care.