"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 Entwistle; Alan Cribb; Ian S. Watt; Zoe C. Skea; John  Owens; Heather M. Morgan; Simon Christmas

doi:10.1016/j.pec.2018.03.028

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

21 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 language	English
Pages (from-to)	1460-1467
Number of pages	8
Journal	Patient Education and Counseling
Volume	101
Issue number	8
Early online date	30 Mar 2018
DOIs	https://doi.org/10.1016/j.pec.2018.03.028
Publication status	Published - Aug 2018

Bibliographical 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.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.pec.2018.03.028Licence: CC BY-NC-ND

The more you know the more you realise it is really challenging to do
https://creativecommons.org/licenses/by-nc-nd/4.0/
Final published version, 398 KBLicence: CC BY-NC-ND

Zoe Skea
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Lecturer (Scholarship), Research Fellow
Person: Academic Related - Scholarship, Academic Related - Research

‘Enabling people to live (and die) well’: enhancing patient care and policy with philosophical research on ‘person-centred’ approaches to healthcare
Vikki Entwistle (Coordinator)
Impact: Societal

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 (Corresponding Author); Cribb, Alan; Watt, Ian S. et al.
In: Patient Education and Counseling, Vol. 101, No. 8, 08.2018, p. 1460-1467.

Research output: Contribution to journal › Article › peer-review

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AU - Morgan, Heather M.

AU - Christmas, Simon

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"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

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Profiles

Zoe Skea

Impacts

‘Enabling people to live (and die) well’: enhancing patient care and policy with philosophical research on ‘person-centred’ approaches to healthcare

Cite this