Optimising person-centred primary care: the need for epistemic reciprocity

Problem

Delivering Person-centred care is a policy priority, yet people living with long-term conditions tell us it isn’t part of the healthcare they receive. In previous research, patients have described that they feel healthcare staff fails to properly listen to individual accounts of living with illness, hence not using those stories to shape treatment decisions. This contributes to a failure of person-centred care. In order to address this problem, we set out to understand how adults with chronic conditions experience the care they receive in primary care settings, and what needs to change to optimise person-centred care.

Approach

Multi-method qualitative design. Forty-two adults with long-term conditions were interviewed about their primary care experiences either individually or in groups.

Analysis – interpretive phenomenological analysis (individual interviews) and thematic analysis (focus groups). Integration of data from both methods through an approach that focused on their complementarity.

Findings

People use experiential knowledge developed through activities of information seeking, experimenting and reflection to learn how to live with their illness. They brought these accounts to primary care settings in the form of patient knowledge to negotiate care. Person-centred experiences were characterised by a ‘clinical negotiation’ between clinician and patient using different types of knowledge and grounded in both the patient’s and the doctor’s sense-making work. This negotiation based on mutual inquiry valued and enhanced the patient’s healthcare experience. We therefore propose a new concept, epistemic reciprocity, as a principle that guides person-centred clinical negotiations fostering the co-creation of new knowledge of patient experience and need through the interactive work of patient and doctor.

Consequences

These findings establish epistemic reciprocity as a core component of person-centred care. We call for its incorporation in clinical practice and education. This would require a redesign of primary care services to support person-centred approaches. At the practice level, changes might focus on timing, headspace, pre-consultation, and post-consultation work. Medical education could also benefit from initiatives that aim to develop scholarship skills across primary care professionals, for example through training in the robust and safe construction of knowledge in practice.