"The more you know, the more you realise it is really challenging to do"

tensions and uncertainties in person-centred support for people with long-term conditions

Vikki A. Entwistle (Corresponding Author), Alan Cribb, Ian S. Watt, Zoe C. Skea, John Owens, Heather M. Morgan, Simon Christmas

Research output: Contribution to journalArticle

5 Citations (Scopus)
11 Downloads (Pure)

Abstract

Objective: To identify and examine tensions and uncertainties in person-centred approaches to self-management support – approaches that take patients seriously as moral agents and orient support to enable them to live (and die) well on their own terms.

Methods: Interviews with 26 UK clinicians about working with people with diabetes or Parkinson’s disease, conducted within a broader interdisciplinary project on self-management support. The analysis reported here was informed by philosophical reasoning and discussions with stakeholders.

Results: Person-centred approaches require clinicians to balance tensions between the many things that can matter in life, and their own and each patient’s perspectives on these. Clinicians must ensure that their supportive efforts do not inadvertently disempower people. When attending to someone’s particular circumstances and perspectives, they sometimes face intractable uncertainties, including about what is most important to the person and what, realistically, the person can or could do and achieve. The kinds of professional judgement that person-centred working necessitates are not always acknowledged and supported.

Conclusion: Practical and ethical tensions are inherent in person-centred support and need to be better understood and addressed.

Practice implications: Professional development and service improvement initiatives should recognise these tensions and uncertainties and support clinicians to navigate them well.
Original languageEnglish
Pages (from-to)1460-1467
Number of pages8
JournalPatient Education and Counseling
Volume101
Issue number8
Early online date30 Mar 2018
DOIs
Publication statusPublished - Aug 2018

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Uncertainty
Self Care
Professional Practice
Parkinson Disease
Interviews

Keywords

  • Support for self-management
  • Person-centred care
  • Patient-centred care
  • Professional-patient relations
  • Patient empowerment
  • Shared decision-making
  • Uncertainty
  • Practical wisdom

Cite this

"The more you know, the more you realise it is really challenging to do" : tensions and uncertainties in person-centred support for people with long-term conditions. / Entwistle, Vikki A. (Corresponding Author); Cribb, Alan; Watt, Ian S.; Skea, Zoe C.; Owens, John ; Morgan, Heather M.; Christmas, Simon.

In: Patient Education and Counseling, Vol. 101, No. 8, 08.2018, p. 1460-1467.

Research output: Contribution to journalArticle

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abstract = "Objective: To identify and examine tensions and uncertainties in person-centred approaches to self-management support – approaches that take patients seriously as moral agents and orient support to enable them to live (and die) well on their own terms.Methods: Interviews with 26 UK clinicians about working with people with diabetes or Parkinson’s disease, conducted within a broader interdisciplinary project on self-management support. The analysis reported here was informed by philosophical reasoning and discussions with stakeholders.Results: Person-centred approaches require clinicians to balance tensions between the many things that can matter in life, and their own and each patient’s perspectives on these. Clinicians must ensure that their supportive efforts do not inadvertently disempower people. When attending to someone’s particular circumstances and perspectives, they sometimes face intractable uncertainties, including about what is most important to the person and what, realistically, the person can or could do and achieve. The kinds of professional judgement that person-centred working necessitates are not always acknowledged and supported.Conclusion: Practical and ethical tensions are inherent in person-centred support and need to be better understood and addressed.Practice implications: Professional development and service improvement initiatives should recognise these tensions and uncertainties and support clinicians to navigate them well.",
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note = "ACKNOWLEDGEMENTS We thank the health professionals who participated in this research and shared their experiences and insights. We thank Louise Cotterell and Bev Smith (Health Services Research Unit, University of Aberdeen) for administrative and clerical support, Darshan Patel and colleagues at the Health Foundation for wonderfully facilitative research management, and NJC Secretarial for transcribing services. This study was funded by the Health Foundation (grant reference 7209). Health Foundation staff took part in one of the knowledge exchange discussions at the end of the project, but played no role in the analysis or writing of this manuscript, for which the authors take full responsibility.",
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N1 - ACKNOWLEDGEMENTS We thank the health professionals who participated in this research and shared their experiences and insights. We thank Louise Cotterell and Bev Smith (Health Services Research Unit, University of Aberdeen) for administrative and clerical support, Darshan Patel and colleagues at the Health Foundation for wonderfully facilitative research management, and NJC Secretarial for transcribing services. This study was funded by the Health Foundation (grant reference 7209). Health Foundation staff took part in one of the knowledge exchange discussions at the end of the project, but played no role in the analysis or writing of this manuscript, for which the authors take full responsibility.

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