Open Access Open Access  Restricted Access Subscription Access

Defining elements of patient-centered care for therapeutic relationships: a literature review of common themes

Stephen Clarke, Carolyn Ells, Brett D Thombs, David Clarke


Rationale and aims: Patient-centered care is a recognized clinical method and ideal for patient - health professional relationships. Many definitions have influenced its evolution. For this research, our aim was: (1) to assess definitions and descriptions of patient-centered care to draw out elements of patient-centered care that are considered to be important markers of successful patient-centered care in the patient - health professional relationship and (2) to propose a set of elements that collectively reflect the diversity of ‘patient-centered’ definitions that describe the patient-professional relationship in this literature. A secondary aim was (3) to provide elements that could be used for development of a quality assessment tool.

Methods: We conducted a critical interpretive review of patient-centered care and patient-centered communication literature, beginning with a critical synthesis that yielded 12 articles that introduced new theoretical and definitional work on patient-centered care and patient-centered communication. We used an inductive and iterative analysis process to identify and group common themes. We used operational language to describe these themes.

Results: We identified 6 elements (each with 2 or more sub-elements) of the patient - health professional relationship that are considered important markers of successful patient-centered care (as found in this literature). The 6 elements are: (1) Engaging the Patient as a Whole Person, (2) Recognizing and Responding to Emotions, (3) Fostering a Therapeutic Alliance, (4) Promoting an Exchange of Information, (5) Sharing Decision-Making and (6) Enabling Continuity of Care, Self-Management and Patient Navigation.

Conclusions: Comparable fundamental elements were common among most authors within this literature: we found that variation in theory was typically a matter of degree and language. This work contributes analyses towards greater theoretical consistency for conceptions of patient-centered care. It also provides avenues for future development of quality assurance benchmarks.


Definitions, literature review, patient-centered care, patient centricity, patient-professional relationship, person-centered healthcare, quality assurance benchmarks, theoretical consistency, whole person care

Full Text:



CMA (Canadian Medical Association). (2008). Achieving Patient-Centred Collaborative Care. Accessed March 29, 2017.

CFPC (College of Family Physicians of Canada). (2009). Patient-centred primary care in Canada. Bring it on home. Discussion Paper. Available at: Accessed March 29, 2017.

IOM (Committee on Quality of Health Care in America, Institute of Medicine). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press. Available at: Accessed March 29, 2017.

Mitnick, S., Leffler, C., Hood, V.L. for the American College of Physicians Ethics, Professionalism and Human Rights Committee. (2010). Family caregivers, patients and physicians: ethical guidance to optimize relationships. Journal of General Internal Medicine 25 (3) 255-260.

Stewart, M., Brown, J.B., Weston, W.W., Freeman, T.R., McWilliam, C.L. (2014). Introduction. In: Patient-centered medicine: transforming the clinical method. 3rd edn. Stewart, M., Brown, J.B., Weston, W.W., McWhinney, I.R. & McWilliam, C.L. & Freeman, T.R., eds. Oxford: Radcliffe Medical Press.

Law, M., Baptiste, S. & Mills, J. (1995). Client-centred practice: What does it mean and does it make a difference? Canadian Journal of Occupational Therapy 62 (5) 250-257.

McKinstry, B. (2000). Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes. British Medical Journal 321 (7265) 867-871.

Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C., Ferrier, K. & Payne, S. (2001). Preferences of patients for patient centred approach to consultation in primary care: observational study. British Medical Journal 322 (7284) 468-472.

Lewin, S., Skea, V.A., Entwistle, V.A., Zwarenstein, M. & Dick, J. (2001). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 4: CD003267.

Dwamena, F., Holmes-Rovner, M., Gaulden, C.M., Jorgenson, S., Sadigh, G., Sikorskii, A., Lewin, S., Smith, R.C., Coffey, J. & Olomu, A. (2012). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 12: CD003267.

Kitson, A., Marshall, A., Bassett, K. & Zeitz, K. (2013). What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing 69 (1) 4-15.

Stewart, M. (2001). Towards a Global Definition of Patient Centred Care: The Patient Should be the Judge of Patient Centred Care. British Medical Journal 322, 444-445.

Hudon, C., Fortin, M., Haggerty, J.L., Lambert, M. & Poitras, M-E. (2011). Measuring Patients’ Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine. Annals of Family Medicine 9 (2) 155-164.

McDougall, R. (2015). Reviewing Literature in Bioethics Research: Increasing Rigour in Non-Systematic Reviews. Bioethics 29 (7) 523-528.

Mead, N. & Bower, P. (2000). Patient-centeredness: a conceptual framework and review of the empirical literature. Social Science & Medicine 51 (7) 1087-1110.

Bechel, D., Myers, W.A. & Smith, D.G. (2000). Does Patient-Centred Care Pay Off? Joint Commission Journal on Quality Improvement 26, 400-409.

Epstein, R.M., Franks, P., Shields, C.S., Meldrum, S.C., Miller, K.N., Campbell, T.L. & Fiscella, K. (2005). Patient-centered communication and diagnostic testing. Annals of Family Medicine 3 (5) 415-421.

McCormack, L.A., Treiman, K., Rupert, D., Williams-Piehota, P., Nadler, E., Arora, N.K., Lawrence, W. & Street Jr., R.L. (2011). Measuring patient-centered communication in cancer care: A literature review and the development of a systematic approach. Social Science & Medicine 72 (7) 1085-1095.

Brown, J.B., Stewart, M., Weston, W.W. & Freeman, T.R. (2003). Introduction. In: Patient-centered medicine: transforming the clinical method (2nd edn.). Stewart, M., Brown, J.B., Weston, W.W., McWhinney, I.R., McWilliam, C.L. & Freeman, T.R., eds. Oxford: Radcliffe Medical Press.

Frampton, S. & Charmel, P. (2009). Introduction. In: Putting patients first: best practices in patient-centered care. Frampton, S. & Charmel, P., eds. Oxford: John Wiley & Sons.

Gerteis, M., Edgman-Levitan, S., Daley, J. & Delbanco, T.L. (1993). Introduction. In: Through the patient's eyes: understanding and promoting patient-centered care. Gerteis, M., Edgman-Levitan, S. & Daley, J, eds. San Francisco, CA: Jossey-Bass.

OMA (Ontario Medical Association). (2010). OMA Policy on Patient-Centred Care. Ontario Medical Review. 34-49. Available at: Accessed March 31, 2017.

Davis, K., Schoenbaum, S.C. & Audet, A-M. (2005). A 2020 vision of patient-centered primary care. Journal of General Internal Medicine 20 (10) 953-957.

Barry, M.J. & Edgman-Levitan, S. (2012). Shared Decision Making - The Pinnacle of Patient-Centered Care. New England Journal of Medicine 366 (9) 780-781.

Van Berckelaer, A., DiRocco, D., Ferguson, M., Gray, P., Marcus, N. & Day, S. (2012). Building a Patient-Centered Medical Home: Obtaining the Patient's Voice. Journal of the American Board of Family Medicine 25 (2) 192-198.

Fredericks, S., Lapum, J., Schwind, J., Beanlands, H., Romaniuk, D. & McCay, E. (2012). Discussion of Patient-Centered Care in Health Care Organizations. Quality Management in Healthcare 21 (3) 127-134.

Epstein, R.M., Franks, P., Fiscella, K., Shields, C.G., Meldrum, S.C., Kravitz, R.L. & Duberstein, P.R. (2005). Measuring patient-centered communication in Patient-Physician consultations: Theoretical and practical issues. Social Sciences & Medicine 61 (7) 1516-1528.

Clayton, M.F., Latimer, S., Dunn, T.W. & Haas, L. (2011). Assessing patient-centered communication in a family practice setting: how do we measure it, and whose opinion matters? Patient Education and Counseling 84 (3) 294-302.

Epstein, R.M. & Street, Jr., R.L. (2007). Patient-centered communication in cancer care: Promoting Healing and Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225. Bethedsa, MD. Available at: Accessed March 31, 2017.

Hanson, J.L. (2008). Shared decision making: Have we missed the obvious? Archives of Internal Medicine 168 (13) 1368-1370.

Fiscella, K., Franks, P., Srinivasan, M., Kravitz, R.L. & Epstein, R. (2007). Ratings of Physician Communication by Real and Standardized Patients. Annals of Family Medicine 5 (2) 151-158.

Zandbelt, L.C., Smets, E.M.A., Oort, F.J., Godfried, M.H. & de Haes, H.C.J.M. (2007). Patient participation in the medical specialist encounter: Does physicians’ patient-centred communication matter? Patient Education and Counseling 65 (3) 396-406.

Levinson, W., Lesser, C.S. & Epstein, R.M. (2010). Developing physician communication skills for patient-centered care. Health Affairs 29 (7) 1310-1318.

Farrell, M.H., Kuruvilla, P., Eskra, K.L., Christopher, S.A. & Brienza, R.S. (2009). A method to quantify and compare clinicians’ assessments of patient understanding during counseling of standardized patients. Patient Education and Counseling 77 (1) 128-135.

Ogden, J., Ambrose, L., Khadra, A., Manthri, S., Symons, L., Vass, A. & Williams, M. (2002). Questionnaire study of GPs’ and patients’ beliefs about the different components of patient centredness. Patient Education and Counseling 47 (3) 223-227.

Hall, M.A., Dugan, E., Zheng, B. & Mishra, A.K. (2001). Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter? The Milbank Quarterly 79 (4) 613-639.

Goodrich J. (2009). Exploring the wide range of terminology used to describe care that is patient-centered. Nursing Times 105 (20) 14-17.

Levinson, W., Gorawara-Bhat, R. & Lamb, J. (2000). A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings. Journal of the American Medical Association 284 (8) 1021-1027.

Beach, W.A., Easter, D.W., Good, J.S. & Pigeron, E. (2005). Disclosing and responding to cancer “fears” during oncology interviews. Social Science & Medicine 60 (4) 893-910.

Kvale, K. (2007). Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs. European Journal of Oncology Nursing 11 (4) 320-327.

Beach, M.C. & Inui, T. (2006). Relationship-Centered Care Research Network. Relationship-centered Care: A Constructive Reframing. Journal of General Internal Medicine 21 (Supplement 1) S3-S8.

Bombeke, K., Symons, L., Debaene, L., De Winter, B., Schol, S. & Van Royen, P. (2010). Help, I’m losing patient-centredness! Experiences of medical students and their teachers. Medical Education 44 (7) 662-673.

Tak, H., Ruhnke, G.W. & Shih, Y-C.Y. (2015). The Association between Patient-Centered Attributes of Care and Patient Satisfaction. The Patient 8 (2) 187-197.

Krupat, E., Bell, R.A., Kravitz, R.L., Thom, D. & Azari, R. (2001). When Physicians and Patients Think Alike: Patient-Centered Beliefs and Their Impact on Satisfaction and Trust. Journal of Family Practice 50 (12) 1057-1062.

Wong, S.T. & Haggerty, J. (2013). Measuring Patient Experience in Primary Health Care: a review and classification of items and scales used in publicly-available questionnaires. Centre for Health Services and Policy Research, University of British Columbia; May 31, 2013. Accessed March 31, 2017.

de Silva, D. (2013). Measuring patient experience. The Health Foundation. Available at: Accessed March 31, 2017.



  • There are currently no refbacks.