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Davidoff (1996) argued that when
practitioners share information with their
patients, patients have the ability to make
sound decisions about their medical care.
Before doctors involve their patients in their
treatment, patients need to express the desire
to collaborate. The literature has shown that
patients place importance on being involved
in decision-making with their physicians
(Vertinsky, Thompson and Uyeno, 1974;
Wensing, Jung, Mainz, Olesen and Grol,
1998). A number of factors influence
whether or not patients would like to
participate in their care. For example,
studies have shown that individuals with
higher incomes and higher levels of
education play a more active role in
provider-client decision-making (Chewning
and Sleuth, 1996). In addition to socioeconomic
status, patients with enough
expertise about the decision they are about
to make are more comfortable participating
in medical decision-making (Chewing and
Sleuth, 1996). Guadagnoli and Ward (1998)
found that patients would also liked to
participate in decision-making if there was
more than one treatment option.
2.3.2.3 Implementation of Patient-
Centred Care in Medicine
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The literature contained few studies on the
implementation of patient-centred care in
general practice. One exception was a study
by Brown, Weston, and Stewart (1989) who
found that framing the interaction between
the patient and physician in the form of an
interview promoted care by allowing for the
definition of problems, goals, and
relationship. The patient interview required
that the physician actively listen to the
patient, let the patient work at her/his own
pace and be sensitive/considerate of what
the patient would like to discuss. Another
study discussed the development of shareddecision
making program which entails a
patient viewing an interview that outlines
their treatment options, and the benefits and
disadvantages of each (Kasper, Mulley, and
Wennberg, 1992).
While there were few implementation
studies, there were numerous studies dealing
with outcomes of patient-centred care that
offer insight into how patient-centred care
could be achieved in general practice.
General practitioners could also derive ideas
about implementation from the work of
Kinmonth, Woodcock, Griffin, Spiegal and
Campbell (1998) who had nurses and
general practitioners attend training sessions
to become familiar with national guidelines,
patient-centred counseling and the practice
of skills. Finally, implementation of patientcentred
care could be achieved by using the
Greenfield, Kaplan, Ware, Yano and Frank
(1988) research intervention used with
diabetes patients. Prior to their consultation
with their physician, diabetic patients went
through their medical chart with a clinical
assistant (Greenfield et al. 1988).
2.3.2.4 Patient-Centred Care Analysis
Quantitative Analysis
There have been a number of observationbased,
quantitative methods used in general
practice to measure the extent to which care
is patient-centred (Stewart, 1995).
Quantitative methods of measurement
include coding of statements between
patients and their physicians (Greenfield et
al., 1988; Kaplan, Greenfield and Ware,
1989), rating scales (Langewitz, Phillipp,
Kiss, and Wossmer; Ockene et al., 1988;
Verhaak, 1988), scales measuring attitudes
and values (Cockburn , Killer, Campbell,
and Sanson-Fisher, 1987; deMonchy,
Richardson, Brown,and Harden, 1988; Grol,
de Maeseneer, Whitfield, and Mokkink,