Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care

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dc.contributor.authorWyer, Peter
dc.contributor.authorSilva, Suzana Alves da
dc.contributor.authorPost, Stephen G
dc.contributor.authorQuinlan, Patricia
dc.date.accessioned2022-08-08T14:54:32Z
dc.date.available2022-08-08T14:54:32Z
dc.date.issued2014-06
dc.description.abstractContemporary health care is increasing in complexity and lacks a unifying understanding of epistemology, methodology and goals. Lack of conceptual consistency in concepts such as 'patient-centred care' (PCC) typifies system-wide discordance. We contrast the fragmented descriptions of PCC and related tools to its own origins in the writings of Balint and to a subsequent construct, relationship-centred care (RCC). We identify the explicit and elaborated connection between RCC and a defined epistemological foundation as a distinguishing feature of the construct and we demonstrate that this makes possible the recognition of alignments between RCC and independently developed constructs. Among these, we emphasize Schon's reflective practice, Nonaka's theory of organizational knowledge creation and the research methodology of realist synthesis. We highlight the relational principles common to these domains and to their common epistemologies and illustrate unsatisfying consequences of adherence to less adequate epistemological frameworks such as positivism. We offer RCC not as an 'antidote' to the dilemmas identified at the outset but as an example that illuminates the value and importance of explicit identification of the premises and assumptions underlying approaches to improvement of the health care system. We stress the potential value of identifying epistemological affinities across otherwise disparate fields and disciplines. Keywords: evidence-based medicine; patient-centred care; person-centred medicine.
dc.identifier.citationWyer PC, Alves Silva S, Post SG, Quinlan P. Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care. J Eval Clin Pract. 2014 Dec;20(6):881-9. doi: 10.1111/jep.12224. Epub 2014 Jul 29. PMID: 25073807.
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/64
dc.language.isoen_US
dc.publisherJournal of Evaluation in Clinical Practiceen
dc.subjectperson-centred medicineen
dc.subjectPatient-centred careen
dc.subjectevidence-based medicineen
dc.subject.meshQuality of Health Careen
dc.subject.meshPhysician-Patient Relationsen
dc.subject.meshPhysician's Roleen
dc.subject.meshPatient-Centered Care / organization & administrationen
dc.subject.meshNurse's Roleen
dc.subject.meshMaleen
dc.subject.meshKnowledgeen
dc.subject.meshHumansen
dc.subject.meshHospital-Patient Relationsen
dc.subject.meshFemaleen
dc.subject.meshEvidence-Based Medicine / organization & administrationen
dc.subject.meshDelivery of Health Care / organization & administrationen
dc.subject.meshAttitude of Health Personnelen
dc.titleRelationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care
dc.typeArticle
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