"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
Health Services Research Unit
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.
Patient Education and Counseling
https://doi.org/10.1016/j.pec.2018.03.028
Support for self-management
Patient-centred care
Professional-patient relations
Shared decision-making
Entwistle, V. A., Cribb, A., Watt, I. S., Skea, Z. C., Owens, J., Morgan, H. M., & Christmas, S. (2018). "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. Patient Education and Counseling, 101(8), 1460-1467. https://doi.org/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. / 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.
Entwistle, VA, Cribb, A, Watt, IS, Skea, ZC, Owens, J, Morgan, HM & Christmas, S 2018, '"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', Patient Education and Counseling, vol. 101, no. 8, pp. 1460-1467. https://doi.org/10.1016/j.pec.2018.03.028
Entwistle VA, Cribb A, Watt IS, Skea ZC, Owens J, Morgan HM et al. "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. Patient Education and Counseling. 2018 Aug;101(8):1460-1467. https://doi.org/10.1016/j.pec.2018.03.028
Entwistle, Vikki A. ; Cribb, Alan ; Watt, Ian S. ; Skea, Zoe C. ; Owens, John ; Morgan, Heather M. ; Christmas, Simon. / "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. In: Patient Education and Counseling. 2018 ; Vol. 101, No. 8. pp. 1460-1467.
@article{906ce5c5ae2041b1bc272dc8d2f0129b,
title = "{"}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 = "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.",
keywords = "Support for self-management, Person-centred care, Patient-centred care, Professional-patient relations, Patient empowerment, Shared decision-making, Uncertainty, Practical wisdom",
author = "Entwistle, {Vikki A.} and Alan Cribb and Watt, {Ian S.} and Skea, {Zoe C.} and John Owens and Morgan, {Heather M.} and Simon Christmas",
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.",
doi = "10.1016/j.pec.2018.03.028",
journal = "Patient Education and Counseling",
publisher = "Elsevier Ireland Ltd",
T1 - "The more you know, the more you realise it is really challenging to do"
T2 - tensions and uncertainties in person-centred support for people with long-term conditions
AU - Entwistle, Vikki A.
AU - Cribb, Alan
AU - Watt, Ian S.
AU - Skea, Zoe C.
AU - Owens, John
AU - Morgan, Heather M.
AU - Christmas, Simon
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.
N2 - 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.
AB - 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.
KW - Support for self-management
KW - Person-centred care
KW - Patient-centred care
KW - Professional-patient relations
KW - Patient empowerment
KW - Shared decision-making
KW - Uncertainty
KW - Practical wisdom
U2 - 10.1016/j.pec.2018.03.028
DO - 10.1016/j.pec.2018.03.028
JO - Patient Education and Counseling
JF - Patient Education and Counseling
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
Final published version, 398 KBLicence: CC BY-NC-ND