Patient-centered care (PCC) is one approach for ameliorating persistent gendered disparities in health care quality, yet no prior research has studied how to achieve patient-centred care for women (PCCW). The purpose of this study was to explore how clinicians deliver PCCW, challenges they face, and the strategies they suggest are needed to support PCCW. We conducted semi-structured qualitative interviews (25–60 min) with clinicians. Thirty-seven clinicians representing 7 specialties (family physicians, cardiologists, cardiac surgeons, obstetricians/gynecologist, psychiatrists, nurses, social workers) who manage depression (n = 16), cardiovascular disease (n = 11) and contraceptive counseling (n = 10), conditions that affect women across the lifespan. We used constant comparative analysis to inductively analyze transcripts, mapped themes to a 6-domain PCC conceptual framework to interpret findings, and complied with qualitative research reporting standards. Clinicians said that women don’t always communicate their health concerns and physicians sometimes disregard women’s health concerns, warranting unique PCC approaches.. Clinicians described 39 approaches they used to tailor PCC for women across 6 PCC domains: foster a healing relationship, exchange information, address emotions/concerns, manage uncertainty, make decisions, and enable self-management. Additional conditions that facilitated PCCW were: privacy, access to female clinicians, accommodating children through onsite facilities, and flexible appointment formats and schedules. Clinicians suggested 7 strategies needed to address barriers of PCCW they identified at the: patient-level (online appointments, transport to health services, use of patient partners to plan and/or deliver services), clinician-level (medical training and continuing professional development in PCC and women’s health), and system-level (funding models for longer appointment times, multidisciplinary teamwork to address all PCC domains). Our research revealed numerous strategies that clinicians can use to optimize PCCW, and health care managers and policy-makers can use to support PCCW through programs and policies. Identified strategies addressed all domains of an established PCC conceptual framework. Future research should evaluate the implementation and impact of these strategies on relevant outcomes such as perceived PCC among women and associated clinical outcomes to prepare for broad scale-up.

中文翻译：

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为女性量身定制以患者为中心的护理的多层次策略：对临床医生的定性访谈


以患者为中心的护理 (PCC) 是改善医疗保健质量方面持续存在的性别差异的一种方法，但之前没有研究研究如何实现以患者为中心的女性护理 (PCCW)。本研究的目的是探讨临床医生如何提供电讯盈科服务、他们面临的挑战以及他们建议支持电讯盈科所需的策略。我们与临床医生进行了半结构化定性访谈（25-60 分钟）。代表 7 个专业（家庭医生、心脏病专家、心脏外科医生、妇产科医生、精神科医生、护士、社会工作者）的 37 名临床医生，负责治疗抑郁症 (n = 16)、心血管疾病 (n = 11) 和避孕咨询 (n = 10) ），影响女性一生的疾病。我们使用持续的比较分析来归纳分析成绩单，将主题映射到 6 域 PCC 概念框架来解释研究结果，并遵守定性研究报告标准。临床医生表示，女性并不总是表达她们的健康问题，医生有时会忽视女性的健康问题，因此需要采取独特的 PCC 方法。临床医生描述了他们在 6 个 PCC 领域为女性量身定制 PCC 的 39 种方法：培养治疗关系、交换信息、解决情绪/担忧、管理不确定性、做出决策并实现自我管理。为电讯盈科提供便利的其他条件包括：隐私、接触女性临床医生、通过现场设施为儿童提供住宿以及灵活的预约形式和时间表。 临床医生提出了解决电讯盈科在以下方面遇到的障碍所需的 7 项策略：患者层面（在线预约、前往医疗服务机构的交通、利用患者合作伙伴来计划和/或提供服务）、临床医生层面（医疗培训和持续专业发展） PCC 和妇女健康领域）和系统层面（更长预约时间的资助模式、解决所有 PCC 领域的多学科团队合作）。我们的研究揭示了临床医生可以用来优化电讯盈科的众多策略，医疗保健管理者和政策制定者可以使用这些策略来通过计划和政策支持电讯盈科。确定的策略涉及已建立的 PCC 概念框架的所有领域。未来的研究应评估这些策略的实施及其对相关结果的影响，例如女性对 PCC 的认知和相关的临床结果，为广泛推广做好准备。