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Learning from patients about patient-centredness: A realist review: BEME Guide No. 60

机译：从患者学习关于患者百分点：一个现实主义评论：Beme指南60

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Background: Patient-centred work is an essential part of contemporary medicine. Literature shows that educational interventions contribute to developing patient-centredness, but there is a lack of insight into the associated learning processes. Objective: Through reviewing articles about educational interventions involving patients, we aspire to develop a program theory that describes the processes through which the educational interventions are expected to result in change. The processes will clarify contextual elements (called contexts) and mechanisms connected to learning patient-centredness. Methods: In our realist review, an initial, rough program theory was generated during the scoping phase, we searched for relevant articles in PubMed, PsycINFO, ERIC, CINAHL and Embase for all years before and through 2016. We included observational studies, case reports, interviews, and experimental studies in which the participants were students, residents, doctors, nurses or dentists. The relevance and rigour of the studies were taken into account during analysis. With deductive as well as inductive coding, we extended the rough program theory. Results: In our review, we classified five different contexts which affect how upcoming professionals learn patient-centredness. These aspects are influenced through components in the intervention(s) related to the learner, the teacher, and the patient. We placed the mechanisms together in four clusters - comparing and combining as well as broadening perspectives, developing narratives and engagement with patients, self-actualisation, and socialisation - to show how the development of (dimensions of) patient-centredness occurs. Three partial-program-theories (that together constituting a whole program theory) were developed, which show how different components of interventions within certain contexts will evoke mechanisms that contribute to patient-centredness. Translation into daily practice: These theories may help us better understand how the roles of patients, learners and teachers interact with contexts such as the kind of knowledge that is considered legitimate or insight in the whole illness trajectory. Our partial program theories open up potential areas for future research and interventions that may benefit learners, teachers, and patients.
机译：背景：以患者为中心的工作是当代医学的重要组成部分。文学表明，教育干预措施有助于发展患者居中，但缺乏有关相关的学习过程的洞察力。目的：通过审查关于涉及患者的教育干预措施的文章，我们渴望制定一个描述教育干预预期导致变革的过程的计划理论。该进程将阐明与学习患者居中的语境元素（称为上下文）和机制。方法：在我们的现实审查中，在范围阶段产生了初始粗略的计划理论，我们在2016年之前和至2016年之前的所有年内搜索了PubMed，Psycinfo，Eric，Cinahl和Embase的相关文章。我们包括观察性研究，案例报告，参与者是学生，居民，医生，护士或牙医的访谈和实验研究。在分析期间考虑了研究的相关性和严谨性。通过演绎以及归纳编码，我们延长了粗略的计划理论。结果：在我们的评论中，我们分类了五种不同的背景，影响了即将到来的专业人员如何学习患者百分比。这些方面受到与学习者，教师和患者有关的干预中的组​​成部分的影响。我们将机制放在四个集群中 - 比较和结合以及扩大观点，发展叙事和与患者的参与，自我实现以及社会化 - 展示如何发生患者百分之规的发展。开发了三个部分计划理论（共同构成整个计划理论），这表明某些情况下的干预措施的不同部件如何唤起有助于患者居中的机制。翻译进入日常练习：这些理论可以帮助我们更好地了解患者，学习者和教师如何与语境相互作用，例如被认为是整个疾病轨迹的合法或洞察力的那种知识。我们的部分方案理论为未来的研究和干预措施开辟了可能受益学习者，教师和患者的潜在领域。

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