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Healthcare students’ attitudes towards patient centred care: a systematic review with meta-analysis

Abstract

Background

Patient centred care is commonly recommended in clinical practice guidelines to improve patient outcomes and reduce healthcare costs. Identifying measurement tools used to assess healthcare students’ attitudes towards patient centered care and determining their attitudes is the first step to ensuring patient centred care is provided in the future. The primary aim of this review was to describe the measurement tools used to assess healthcare students’ attitudes towards patient centred care. The secondary aim was to quantify healthcare students’ attitudes towards patient centred care.

Methods

An electronic database search was conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with combined terms relating to ‘patient centred care’, ‘attitudes’, and ‘healthcare students’. Studies that quantitatively assessed healthcare students’ attitudes towards patient centred care were included. Measurement tools used in the included studies were qualitatively described. Meta-analysis was conducted to quantify healthcare students’ attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students’ attitudes towards patient centred care.

Results

The electronic search identified 3948 total studies. One hundred twenty-nine full texts were screened, and 49 studies were included. There were 16 measurement tools used to assess healthcare students’ attitudes towards patient centered care. Most studies (53%, n = 26) used the Patient-Practitioner Orientation Scale (PPOS) to assess patient centered care. Meta-analyses of 20 studies with 26 total groups resulted in a pooled mean PPOS score of 4.16 on a 0–6 scale (95% Confidence Interval [CI]: 3.95, 4.37), indicating low attitudes towards patient centered care. Additional analyses found that women have significantly higher attitudes towards patients centred care than men (pooled effect 0.14 [95% CI: 0.05, 0.23], n = 8 studies) and mean PPOS scores appear similar among sub-groups of only medical students (pooled mean 4.13, 95% CI: 3.85, 4.42, n = 13 studies) and only American healthcare students (pooled mean 4.49, 95% CI: 4.35, 4.64, n = 5 studies).

Conclusions

Several different measurement tools have been used to assess healthcare students’ attitudes towards patient centred care, but the most commonly used is the PPOS. Our results indicate that healthcare students have low attitudes towards patient centred care. Future studies should evaluate if attitudes towards patient centred care can be improved during healthcare education.

Peer Review reports

Background

Patient centred care occurs when healthcare providers are respectful of and responsive to patient preferences, needs and values, and ensures patient values guide all clinical decisions [1]. Patient centred care is multi-dimensional. For example, Mead an Bower [2] describe patient centred care as having five dimensions including a biopsychosocial perspective, the patient as a person, sharing power and responsibility, the therapeutic alliance, and the doctor as a person.

Using a patient centred care approach to deliver healthcare has been shown to reduce healthcare costs while improving patient outcomes [3, 4]. Unfortunately, not all healthcare professionals have positive attitudes towards patient centred care and attitudes vary between specialties [5]. Ensuring healthcare students have positive attitudes towards patient centred care is an important starting point to increase the number of healthcare professionals providing patient centred care. However, previous studies assessing healthcare students’ attitudes towards patient centred care have found mixed results. Some show that a large proportion of healthcare students have positive attitudes towards patient centred care, [6] while others show the opposite [7].

One possible explanation for these inconsistent findings is variation in the measurement tools used to assess attitudes towards patient centred care (e.g. Patient-Practitioner Orientation Scale [PPOS], Doctor-Patient Scale) [8, 9]. Understanding the different measurement tools used to assess healthcare students’ attitudes towards patient centred care is an important first step towards summarizing the available evidence on healthcare students’ attitudes towards patient centred care. Therefore, the primary aim of this study was to describe the measurement tools used to assess healthcare students’ attitudes towards patient centred care. Secondary aims were to quantify healthcare students’ attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students’ attitudes towards patient centred care.

Methods

This systematic review has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) [10] and preregistered on Open Science Framework [11]. The PRISMA checklist is provided in Appendix 1.

Search strategy

An electronic database search strategy was developed with a health sciences librarian and searches were conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with no language restriction. The search strategy and search terms were informed by previous reviews on patient centred care [12] and healthcare students [13]. Our search strategy combined terms relating to ‘patient centred care’, ‘attitudes’, and ‘healthcare students’ and was designed to capture studies investigating healthcare students attitudes towards patient centred care as per our preregistered protocol. The full MEDLINE search strategy is available in Appendix 2. Forward citation tracking was performed in Web of Science. All studies identified by our search strategy were retrieved and managed using Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia).

Study eligibility criteria

Studies that quantitatively assessed healthcare students’ (e.g. physical therapy, chiropractic, medicine, nursing, dentistry, etc.) attitudes towards patient centred care were included. Studies that measured mixed student and professional populations were included however, only if it was possible to extract data for students separately. Studies were not excluded based on language or type of measurement, provided it was quantitative. Qualitative studies and studies including only qualified health professionals were excluded.

Study selection

Study selection was conducted in two phases: (I) the title and abstract review phase, and (II) the full text review phase. If a paper met inclusion criteria in phase (I), the full text was retrieved and reviewed for potential inclusion. Two reviewers (GB and BC) conducted title and abstract selection and full text review independently. Any disagreements were resolved by discussion or consultation with a third reviewer (JJY).

Data extraction

Two reviewers (GB and BC) independently extracted individual study characteristics. Demographic data extracted included: author name, title, date of publication, journal, location of study, year of study completion, sample size and student characteristics (age, sex, profession). Data extraction items for study aims included: name of measurement tool and subscales, exact construct, number of items, and scoring for patient centred care measures (mean and standard deviation [SD] median interquartile range [IQR], author defined proportion of students who have positive attitudes towards patient centred care), and scoring across different sub-groups (e.g. based on age, sex, profession type). Any discrepancies were resolved by discussion between the two reviewers. Study authors were contacted when relevant data was not reported. In our protocol, we planned to extract effect measures (Odds Ratios, Risk Ratios or correlation coefficients) and measures of variability for associations between various predictor variables (e.g. age, sex, profession type) and attitudes towards patient centred care. However, no included studies reported this data.

Risk of bias/study quality assessment

The methodological quality of included studies was assessed independently by two reviewers (GB and BC) using a modified version of the Downs and Black checklist (Appendix 3). We modified the original 27-item Downs and Black checklist [14] and selected 10 items that were relevant to studies assessing attitudes towards patient centred care. Selection of items to include in the modified Downs and Black checklist was decided by consensus between study authors prior to conducting the search. The individual studies were scored from 0 to 10 based on reporting clear objectives, outcomes, characteristics of included patients, findings, estimates of the random variability, actual probability values, recruitment and sample characteristics suggesting representativeness, appropriate statistical tests, and accurate outcome measures. A detailed description of the modified Downs and Black checklist is provided in Appendix 3. Any disagreements between the two reviewers were resolved through discussion.

Data analysis

Characteristics of measurement tools used to assess attitudes towards patient centred care (e.g., name of tool, measurement construct, subscales, number of items) were qualitatively summarized. Quantitative data on attitudes towards patient centred care (mean (SD) or n (%)] was pooled when studies were considered sufficiently homogenous in terms of population and measure used to assess attitudes towards patient centred care. Meta-analysis was performed using the inverse-variance method with the Hartung-Knapp adjustment for random effects models [15]. Statistical heterogeneity was assessed using the I2 statistic [16]. The I2 statistic was interpreted as might not be important (0% to 40%), may represent moderate heterogeneity (30% to 60%), may represent substantial heterogeneity (50% to 90%), or considerable heterogeneity (75% to 100%) [17]. Analyses of factors that may influence healthcare students attitudes towards patient centred care were conducted on available variables (sex, medical students only, and United States [U.S.] medical students only) to explore whether any observed heterogeneity was due to differences in sex, profession, or geographical location across studies. Meta-analysis was conducted using R statistical software (https://www.r-project.org).

Results

The initial electronic database search identified 3948 potentially eligible studies. After removing duplicates and screening studies by title and abstract, 129 potentially eligible studies for inclusion were considered and their full text was retrieved. After full text screening, 49 studies [6,7,8,9, 18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] met the inclusion criteria and were included in the review with 20 studies (n = 8050) [6, 7, 9, 18, 25, 26, 28,29,30,31,32, 36, 39, 43, 45, 46, 49, 52, 54, 55] providing sufficient data for meta-analysis. Two studies were conducted using the same data set as other included studies therefore, we only used data from the original report in our meta-analysis [63, 64]. The PRISMA flowchart of studies through the review is provided in Fig. 1.

Fig.1
figure 1

PRISMA flow chart of the records and study selection process

The authors of twelve studies were contacted for additional data and were ultimately excluded due to inability to retrieve data needed to determine whether they assessed healthcare students attitudes’ towards patient centred care [65,66,67,68,69,70,71,72,73,74,75,76].

Characteristics of included trials

The 49 included studies used 16 different measurement tools to investigate healthcare students’ attitudes towards patient centred care, with sample sizes ranging from 32 to 3191 students. The majority of studies assessed U.S. healthcare students’ attitudes (40.8%) followed by United Kingdom healthcare students (8%). A comprehensive description of each study is provided in Table 1. Twenty-six studies (53%) used the PPOS measurement tool while three different modified versions of the PPOS were used in one study each. The Readiness for Interprofessional Learning Scale (RIPLS), Doctor-Patient Scale, and Interprofessional Attitudes Scale (IPAS) were each used in five, four, and two studies, respectively. The Health Beliefs Attitudes survey, Nelson-Jones and Patterson Counsellor Attitude scale, Patient-Centredness Multi-Choice Questionnaire, and Tucker-Culturally Sensitive Health Care Inventory Provider form were each used in one study. Five studies used measurement tools with no name reported. A qualitative description of all the measurement tools used in the included studies is provided in Table 2.

Table 1 Characteristics of included studies
Table 2 Measurement tools and their subscales identified in the included studies

Mean methodological quality assessed using a modified 10-item Downs and Black checklist was 9.04 (95% Confidence Interval [CI]: 8.73, 9.35; minimum 6; maximum 10). The most commonly omitted methodological quality indicators were a lack of appropriate reporting of probability values, subjects not being representative of the entire population from which they were recruited, and participants not being representative of the population from which they were recruited. A comprehensive breakdown of the methodological quality for each study is provided in Appendix 4.

Healthcare students’ attitudes towards patient centred care

Due to limited data, we were only able to perform a meta-analysis of studies that used the PPOS (0–6 scale) to assess healthcare students’ attitudes towards patient centred care. There were 20 studies with 26 total groups included in the meta-analysis (n = 8050). Most studies analyzed medical students (n = 18) followed by a mix of healthcare students (n = 2), nursing (n = 1), physician assistant (n = 1), dentistry (n = 1), speech therapy (n = 1), chiropractic (n = 1), and physical therapy (n = 1) students. Overall, the pooled mean score on the PPOS was 4.16 (95% CI: 3.95, 4.37; I2: 100%) (Fig. 2).

Fig. 2
figure 2

Forest plot of mean pooled PPOS score and 95% CI for healthcare students

Factors influence on attitudes towards patient centred care

Sex, profession, and geographical location were the only factors with data available to conduct analyses to address our secondary aim of potential influence on healthcare students’ attitudes towards patient centred care. Three analyses (sex, only medical students, and only medical students in the U.S.) were conducted attempting to explain heterogeneity. Eight studies reported PPOS data stratified by sex. Among these, there were 3175 total healthcare students included (1626 men and 1549 women). The total PPOS mean score was slightly higher in women (MD 0.14, 95% CI: 0.05, 0.23; I2: 80%, n = 8 studies) (Fig. 3). PPOS mean scores were similar among subgroups of only medical students with a pooled mean score of 4.13 (95% CI: 3.85, 4.42; I2: 100%, n = 13 studies with 18 total groups) (Fig. 4a) and only U.S. medical students with a mean score of 4.49 (95% CI: 4.35, 4.64; I2: 95%, n = 5 studies with 7 total groups) (Fig. 4b). Hence, none of the analyses was able to substantially explain the heterogeneity found in the meta-analysis.

Fig. 3
figure 3

Forest plot of mean PPOS score and 95% CI difference between female and male healthcare students

Fig. 4
figure 4

a-b Forest plots of mean PPOS score and 95% CI for medical students only

Discussion

This is the first systematic review to summarize the measurement tools used to assess healthcare students’ attitudes towards patient centred care and quantify their attitudes. There were 16 measurement tools used to assess attitudes towards patient centred care across 49 included studies with the most common being the PPOS. Women have slightly higher attitudes towards patient centred care compared to men, and medical students, particularly those from the U.S., have slightly higher attitudes towards patient centred care than healthcare students’ overall.

Patient centred care is consistently recommended in clinical practice guidelines for a variety of conditions (e.g., musculoskeletal pain, depression, end of life care etc.) [77,78,79]. Additionally, research suggests that patient centred care is associated with higher patient satisfaction [80, 81], improved patient outcomes [3, 4, 82], and lower healthcare costs [83, 84]. Unfortunately, our findings indicate that students have low attitudes towards patient centred care overall, according to the classification by Krupat et al. [80]. Mean PPOS scores should be interpreted as high (mean score > 5.00; patient centred), medium (mean score 4.57–4.99), or low (mean score < 4.57, doctor centred). Meta-analysis of studies in our review reported a total mean score of 4.16 on the PPOS. Our findings are similar to a recent systematic review that included four studies measuring physicians’ attitudes towards patient centred care using the PPOS [12]. Those four studies reported total mean PPOS scores of 3.98, 4.08, 4.55, and 4.97 [5, 81, 85, 86]. The PPOS has demonstrated acceptable validity and adequate reliability among healthcare students [70, 87, 88]. While healthcare students are learning new information during their education and have limited time to focus on other aspects of patient care, the results of our review and Pollard et al. [12] indicate that both healthcare students and professionals have low attitudes towards patient centred care. Due to the known positive effect of patient centred care on healthcare outcomes and costs, it is important to develop and test strategies to improve healthcare students’ and professionals’ attitudes towards and implementation of patient centred care.

We found that female healthcare students have higher attitudes towards patient centred compared to males, which is similar to previous studies [70]. However, the difference between males and females was small and both groups would still be classified as having low attitudes towards patient centred care. These results imply that healthcare students require training to improve attitudes towards patient centred care and special considerations may be required for male students, but the importance of the observed difference between males and females is not clear. Analysis of only medical students found similar mean PPOS score as overall healthcare students indicating that attitudes may not differ widely between healthcare professions. However, medical students from the U.S. reported higher attitudes towards patient centred care compared to healthcare students’ overall, but again, the pooled mean score of the attitudes were still considered low towards patient centred care [6, 25, 29, 31, 36]. These results imply that there may be cultural or societal differences that may influence attitudes towards patient centred care.

Future studies assessing healthcare students’ attitudes towards patient centred care should use the PPOS to allow for comparability to previous literature or aim to validate existing tools. Many studies (41%) included in our systematic review used tools that have not demonstrated validity and reliability or have been used only once, making it difficult to interpret and compare the results of studies. Studies using a different measurement tool should look to validate and compare the psychometric properties with the PPOS.

There were only self-reported measurement tools (e.g., PPOS, RIPLS, Doctor-Patient Scale, IPAS etc.) found in our review therefore, there may be a need for objective tools used to measure patient centred care. Longitudinal studies are also needed to assess whether healthcare students’ attitudes persist into clinical practice or if attitudes evolve throughout training and with years of clinical experience. Additionally, future studies should evaluate if healthcare education can positively influence and increase healthcare students’ attitudes towards patient centred care.

Our systematic review has some limitations. We found high heterogeneity in our main meta-analyses, and this could not be explained with analyses of available factors that may influence attitudes towards patient centred care. We only included studies in English, so it is possible important data from non-English articles was missed. Additionally, our electronic database search was not conducted in all available databases, such as the Education Resources Information Center (ERIC) database or grey literature, manual searching of educational journals was not conducted, nor was pursuing the publications of relevant scholars and authors was conducted. Therefore, it is possible that relevant studies were not captured. However, our search strategy was tested independently by two research librarians, reference list screening was performed, and since all studies were related to healthcare students, it is likely they would be indexed in medical and healthcare databases. Therefore, it is unlikely that relevant literature was not included. The results of medical students and U.S. medical students only should be interpretated with caution since the majority of included studies were conducted in the U.S. therefore the results may not represent non-U.S. healthcare students.

Conclusions

We identified 16 different measurement tools that have been used to assess healthcare students’ attitudes towards patient centred care, with the most popular being the PPOS. Our results suggest that healthcare students have low attitudes towards patient centred care when measured by the PPOS. There is considerable opportunity to increase healthcare students’ attitudes toward patient centred care in order to improve patient outcomes and decrease healthcare costs. Universities have a unique opportunity to shape their curriculum to emphasize features of patient centred care. Specific classes to practice, role-play, and discuss ways to increase the dimensions of patient centred care (e.g., biopsychosocial perspective, the patient as a person, sharing power and responsibility,therapeutic alliance, and doctor as a person) may allow for increased attitudes towards patient centred care by healthcare students. This increase in attitude towards patient centred care and the dimensions that encompass it may lead to a better patient-doctor relationship that has previously led to decrease healthcare costs.

Availability of data and materials

The authors included all data relevant to the study in the manuscript or appendix.

Abbreviations

PPOS:

Patient-Practitioner Orientation Scale

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols

SD:

Standard deviation

IQR:

Median interquartile range

CI:

Confidence interval

U.S.:

United States

RIPLS:

Readiness for Interprofessional Learning Scale

IPAS:

Interprofessional Attitudes Scale

References

  1. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century [Internet]. Washington (DC): National Academies Press (US); 2001. Available from:  http://www.ncbi.nlm.nih.gov/books/NBK222274/. Cited 13 Feb 2021

    Google Scholar 

  2. Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087–110.

    Article  Google Scholar 

  3. Ferreira PH, Ferreira ML, Maher CG, Refshauge KM, Latimer J, Adams RD. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93(4):470–8.

    Article  Google Scholar 

  4. Fuentes J, Armijo-Olivo S, Funabashi M, Miciak M, Dick B, Warren S, et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther. 2014;94(4):477–89.

    Article  Google Scholar 

  5. Chan CMH, Ahmad WAW. Differences in physician attitudes towards patient-centredness: across four medical specialties. Int J Clin Pract. 2012;66(1):16–20.

    Article  Google Scholar 

  6. Haidet P, Dains JE, Paterniti DA, Chang T, Tseng E, Rogers JC. Medical students’ attitudes toward patient-centered care and standardized patients’ perceptions of humanism: a link between attitudes and outcomes. Acad Med J Assoc Am Med Coll. 2001;76(10 Suppl):S42-44.

    Article  Google Scholar 

  7. Lee KH, Seow A, Luo N, Koh D. Attitudes towards the doctor-patient relationship: a prospective study in an Asian medical school. Med Educ. 2008;42(11):1092–9.

    Article  Google Scholar 

  8. Bombeke K, Van Roosbroeck S, De Winter B, Debaene L, Schol S, Van Hal G, et al. Medical students trained in communication skills show a decline in patient-centred attitudes: an observational study comparing two cohorts during clinical clerkships. Patient Educ Couns. 2011;84(3):310–8.

    Article  Google Scholar 

  9. Ribeiro MMF, Krupat E, Amaral CFS. Brazilian medical students’ attitudes towards patient-centered care. Med Teach. 2007;29(6):e204-208.

    Article  Google Scholar 

  10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(372): n71.

    Article  Google Scholar 

  11. Bejarano G, Csiernik B, Young JJ, Stuber DK, Zadro J. Healthcare students attitudes toward patient centered care: A Systematic Review Protocol. 2021. Available from: https://osf.io/r9273/. Cited 6 Oct 2021

    Google Scholar 

  12. Pollard S, Bansback N, Bryan S. Physician attitudes toward shared decision making: A systematic review. Patient Educ Couns. 2015;98(9):1046–57.

    Article  Google Scholar 

  13. Lewis KL, Battaglia PJ. Knowledge of psychosocial factors associated with low back pain amongst health science students: a scoping review. Chiropr Man Ther. 2019;27(1):64.

    Article  Google Scholar 

  14. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.

    Article  Google Scholar 

  15. Hartung J, Knapp G. On tests of the overall treatment effect in meta-analysis with normally distributed responses. Stat Med. 2001;20(12):1771–82.

    Article  Google Scholar 

  16. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  Google Scholar 

  17. Deeks JJ, Higgins JP, Altman DG. Analysing data and undertaking meta-analyses. In: Cochrane Handbook for Systematic Reviews of Interventions [Internet]. Hoboken: Wiley; 2019 p. 241–84. Available from: https://doi.org/10.1002/9781119536604.ch10. Cited 24 Feb 2021.

  18. Ahmad W, Krupat E, Asma Y, Fatima NE, Attique R, Mahmood U, et al. Attitudes of medical students in Lahore Pakistan towards the doctor-patient relationship. PeerJ. 2015;3:e1050.

    Article  Google Scholar 

  19. Balentine CJ, Ayanbule F, Haidet P, Rogers J, Thompson B, Chang T, et al. The patient-physician relationship in surgical students. Am J Surg. 2010;200(5):624–7.

    Article  Google Scholar 

  20. Batenburg V. Do professional attitudes change during medical education? Adv Health Sci Educ Theory Pract. 1996;1(2):153–64.

    Article  Google Scholar 

  21. Batenburg V, Smal JA, Lodder A, de Melker RA. Are professional attitudes related to gender and medical specialty? Med Educ. 1999;33(7):489–92.

    Article  Google Scholar 

  22. Beach MC, Rosner M, Cooper LA, Duggan PS, Shatzer J. Can Patient-Centered Attitudes Reduce Racial and Ethnic Disparities in Care? Acad Med J Assoc Am Med Coll. 2007;82(2):193–8.

    Article  Google Scholar 

  23. Burnard P, Morrison P. Client-centred counselling: a study of nurses’ attitudes. Nurse Educ Today. 1991;11(2):104–9.

    Article  Google Scholar 

  24. Davis D, Koppelman D, Gordon J, Coleman S, Heitzler E, Fall-Dickson J. Effect of an Academic-Community Partnership Simulation Education Program on Quality and Safety Education for Nurses Competency Domains for Bachelor of Science in Nursing Students. Clin Simul Nurs. 2018;1(18):56–63.

    Article  Google Scholar 

  25. Davis KS, Magruder KM, Lin Y, Powell CK, Clancy DE. Brief report: Trainee provider perceptions of group visits. J Gen Intern Med. 2006;21(4):357–9.

    Article  Google Scholar 

  26. Dockens AL, Bellon-Harn ML, Manchaiah V. Preferences to Patient-Centeredness in Pre-Service Speech and Hearing Sciences Students: A Cross-Sectional Study. J Audiol Otol. 2016;20(2):73–9.

    Article  Google Scholar 

  27. El-Awaisi A, Awaisu A, El Hajj MS, Alemrayat B, Al-Jayyousi G, Wong N, et al. Delivering Tobacco Cessation Content in the Middle East Through Interprofessional Learning. Am J Pharm Educ. 2017;81(5):91.

    Article  Google Scholar 

  28. Fothan AM, Eshaq AM, Bakather AM. Medical Students’ Perceptions of the Doctor-Patient Relationship: A Cross-Sectional Study from Saudi Arabia. Cureus. 2019;11(7):e5053.

    Google Scholar 

  29. Gaufberg E, Dunham L, Krupat E, Stansfield B, Christianson C, Skochelak S. Do Gold Humanism Honor Society Inductees Differ From Their Peers in Empathy, Patient-Centeredness, Tolerance of Ambiguity, Coping Style, and Perception of the Learning Environment? Teach Learn Med. 2018;30(3):284–93.

    Article  Google Scholar 

  30. Grilo AM, Santos MC, Rita JS, Gomes AI. Assessment of nursing students and nurses’ orientation towards patient-centeredness. Nurse Educ Today. 2014;34(1):35–9.

    Article  Google Scholar 

  31. Haidet P, Dains JE, Paterniti DA, Hechtel L, Chang T, Tseng E, et al. Medical student attitudes toward the doctor-patient relationship. Med Educ. 2002;36(6):568–74.

    Article  Google Scholar 

  32. Hammerich K, Stuber K, Hogg-Johnson S, Abbas A, Harris M, Lauridsen HH, et al. Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey. Chiropr Man Ther [Internet]. 2019;27:46 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739992/. Cited 7 Dec 2020.

    Article  Google Scholar 

  33. Hardeman RR, Burgess D, Phelan S, Yeazel M, Nelson D, van Ryn M. Medical student socio-demographic characteristics and attitudes toward patient centered care: do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study. Patient Educ Couns. 2015;98(3):350–5.

    Article  Google Scholar 

  34. Harris M, Camenzind A-L, Fankhauser R, Streit S, Hari R. Does a home-based interview with a chronically ill patient help medical students become more patient-centred? A randomised controlled trial. BMC Med Educ. 2020;20(1):217.

    Article  Google Scholar 

  35. Hauer KE, Boscardin C, Gesundheit N, Nevins A, Srinivasan M, Fernandez A. Impact of student ethnicity and patient-centredness on communication skills performance. Med Educ. 2010;44(7):653–61.

    Article  Google Scholar 

  36. Henschen BL, Bierman JA, Wayne DB, Ryan ER, Thomas JX, Curry RH, et al. Four-Year Educational and Patient Care Outcomes of a Team-Based Primary Care Longitudinal Clerkship. Acad Med J Assoc Am Med Coll. 2015;90(11 Suppl):S43-49.

    Article  Google Scholar 

  37. Hirsh D, Gaufberg E, Ogur B, Cohen P, Krupat E, Cox M, et al. Educational outcomes of the Harvard Medical School-Cambridge integrated clerkship: a way forward for medical education. Acad Med J Assoc Am Med Coll. 2012;87(5):643–50.

    Article  Google Scholar 

  38. Hudson JN, Lethbridge A, Vella S, Caputi P. Decline in medical students’ attitudes to interprofessional learning and patient-centredness. Med Educ. 2016;50(5):550–9.

    Article  Google Scholar 

  39. Hur Y, Cho AR, Choi CJ. Medical students’ and patients’ perceptions of patient-centred attitude. Korean J Med Educ. 2017;29(1):33–9.

    Article  Google Scholar 

  40. King S, Violato E. Longitudinal evaluation of attitudes to interprofessional collaboration: time for a change? J Interprof Care. 2021;35(1):124–31.

    Article  Google Scholar 

  41. Krupat E, Pelletier S, Alexander EK, Hirsh D, Ogur B, Schwartzstein R. Can changes in the principal clinical year prevent the erosion of students’ patient-centered beliefs? Acad Med J Assoc Am Med Coll. 2009;84(5):582–6.

    Article  Google Scholar 

  42. Liu W, Hao Y, Zhao X, Peng T, Song W, Xue Y, et al. Gender differences on medical students’ attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang. China PeerJ. 2019;7:e7896.

    Article  Google Scholar 

  43. Madhan B, Rajpurohit AS, Gayathri H. Attitudes of postgraduate orthodontic students in India towards patient-centered care. J Dent Educ. 2011;75(1):107–14.

    Article  Google Scholar 

  44. Mcnair R, Griffiths L, Reid K, Sloan H. Medical students developing confidence and patient centredness in diverse clinical settings: A longitudinal survey study. BMC Med Educ. 2016;15:16.

    Google Scholar 

  45. Meirovich A, Ber R, Moore M, Rotschild A. Student-centered tutoring as a model for patient-centeredness and empathy. Adv Med Educ Pract. 2016;7:423–8.

    Article  Google Scholar 

  46. Michael K, Dror M, Karnieli-Miller O. Students’ patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy. Patient Educ Couns. 2019;1:102.

    Google Scholar 

  47. Mirsu-Paun A, Tucker CM, Hardt NS. Medical students’ self-evaluations of their patient-centered cultural sensitivity: implications for cultural sensitivity/competence training. J Natl Med Assoc. 2012;104(1–2):38–45.

    Google Scholar 

  48. Moore M. What do Nepalese medical students and doctors think about patient-centred communication? Patient Educ Couns. 2009;76(1):38–43.

    Article  Google Scholar 

  49. Mudiyanse RM, Pallegama RW, Jayalath T, Dharmaratne S, Krupat E. Translation and validation of patient-practitioner orientation scale in Sri Lanka. Educ Health Abingdon Engl. 2015;28(1):35–40.

    Article  Google Scholar 

  50. Noble LM, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Med Educ. 2007;41(5):432–40.

    Article  Google Scholar 

  51. Norris J. The Development and Validation of the Interprofessional Attitudes Scale. Acad Med. 2015;18:90.

    Google Scholar 

  52. Pers M, Górski S, Stalmach-Przygoda A, Balcerzak Ł, Szopa M, Karabinowska A, et al. Clinical communication course and other factors affecting patient-centered attitudes among medical students. Folia Med Cracov. 2019;59(2):81–92.

    Google Scholar 

  53. Rolfe G. Some factors associated with change in patient-centredness of student nurses during the Common Foundation Programme in Nursing. Int J Nurs Stud. 1994;31(5):421–36.

    Article  Google Scholar 

  54. Rosewilliam S, Indramohan V, Breakwell R, Liew BXW, Skelton J. Patient-centred orientation of students from different healthcare disciplines, their understanding of the concept and factors influencing their development as patient-centred professionals: a mixed methods study. BMC Med Educ. 2019;19(1):347.

    Article  Google Scholar 

  55. Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns. 2011;85(3):529–32.

    Article  Google Scholar 

  56. Šter MP, Švab I, Klemenc-Ketiš Z, Kersnik J. Development and validation of a questionnaire for evaluation of students’ attitudes towards family medicine. Coll Antropol. 2015;39(1):1–10.

    Google Scholar 

  57. Stoner AM, Cannon M, Shan L, Plewa D, Caudell C, Johnson L. The Other 45: Improving Patients’ Chronic Disease Self-Management and Medical Students’ Communication Skills. J Am Osteopath Assoc. 2018;118(11):703–12.

    Google Scholar 

  58. Sweeney K, Baker P. Promoting empathy using video-based teaching. Clin Teach. 2018;15(4):336–40.

    Article  Google Scholar 

  59. Tsimtsiou Z, Kerasidou O, Efstathiou N, Papaharitou S, Hatzimouratidis K, Hatzichristou D. Medical students’ attitudes toward patient-centred care: a longitudinal survey. Med Educ. 2007;41(2):146–53.

    Article  Google Scholar 

  60. Bacon CEW, Van Lunen BL, Hankemeier DA. Postprofessional Athletic Training Students’ Perceptions Concerning the Health Care Competencies. Athl Train Educ J. 2018;13(4):309–23.

    Article  Google Scholar 

  61. Zaudke JK, Paolo A, Kleoppel J, Phillips C, Shrader S. The Impact of an Interprofessional Practice Experience on Readiness for Interprofessional Learning. Fam Med. 2016;48(5):371–6.

    Google Scholar 

  62. Zeeni N, Zeenny R, Hasbini-Danawi T, Asmar N, Bassil M, Nasser S, et al. Student perceptions towards interprofessional education: Findings from a longitudinal study based in a Middle Eastern university. J Interprof Care. 2016;30(2):165–74.

    Article  Google Scholar 

  63. Rolfe G. The Patient-Centredness Multi-Choice Questionnaire: developing an instrument for the measurement of patient-centredness in student nurses. J Adv Nurs. 1993;18(1):120–6.

    Article  Google Scholar 

  64. Mirsu-Paun A, Tucker CM, Herman KC, Hernandez CA. Validation of a provider self-report inventory for measuring patient-centered cultural sensitivity in health care using a sample of medical students. J Community Health. 2010;35(2):198–207.

    Article  Google Scholar 

  65. Hong BS, Kim TH, Seo JS, Kim TW, Moon SW. Comparison of Patient-centeredness Changes between Medical School Graduates and Medical Students after Psychiatric Clerkship. Korean J Med Educ. 2009;21(2):133–42.

    Article  Google Scholar 

  66. Zeldow PB, Daugherty SR. The stability and attitudinal correlates of warmth and caring in medical students. Med Educ. 1987;21(4):353–7.

    Article  Google Scholar 

  67. Wahlqvist M, Gunnarsson RK, Dahlgren G, Nordgren S. Patient-centred attitudes among medical students: gender and work experience in health care make a difference. Med Teach. 2010;32(4):e191-198.

    Article  Google Scholar 

  68. Hur Y, Kim S, Park JH, Cho A-R, Choi CJ. Changes in medical students’ patient-centeredness attitudes by implementation of clinical performance examination. Korean J Med Educ. 2014;26(2):99–106.

    Article  Google Scholar 

  69. Hall JA, Ship AN, Ruben MA, Curtin EM, Roter DL, Clever SL, et al. Clinically relevant correlates of accurate perception of patients’ thoughts and feelings. Health Commun. 2015;30(5):423–9.

    Article  Google Scholar 

  70. Krupat E, Hiam CM, Fleming MZ, Freeman P. Patient-centeredness and its correlates among first year medical students. Int J Psychiatry Med. 1999;29(3):347–56.

    Article  Google Scholar 

  71. Hurley EA, Doumbia S, Kennedy CE, Winch PJ, Roter DL, Murray SM, et al. Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study. BMJ Open. 2018;8(1):e019224.

    Article  Google Scholar 

  72. Al-Bawardy R, Blatt B, Al-Shohaib S, Simmens SJ. Cross-cultural comparison of the patient-centeredness of the hidden curriculum between a Saudi Arabian and 9 US medical schools. Med Educ Online. 2009;18(14):19.

    Google Scholar 

  73. Hall JA, Roter DL, Blanch DC, Frankel RM. Nonverbal Sensitivity in Medical Students: Implications for Clinical Interactions. J Gen Intern Med. 2009;24(11):1217–22.

    Article  Google Scholar 

  74. Taylor J, Smith A. Pharmacy Student Attitudes to Patient Education: A Longitudinal Study. Can Pharm J Rev Pharm Can. 2010;143(5):234–9.

    Google Scholar 

  75. Shankar PR, Dubey A, Palaian S, Deshpande V. Attitudes of First-Year Medical Students Towards the Doctor Patient Relationship. JNMA J Nepal Med Assoc. 2006;1(45):196–203.

    Google Scholar 

  76. Burgess DJ, Hardeman RR, Burke SE, Cunningham BA, Dovidio JF, Nelson DB, et al. Incoming medical students’ political orientation affects outcomes related to care of marginalized groups: Results from the medical student CHANGES study. J Health Polit Policy Law. 2019;44(1):113–46.

    Article  Google Scholar 

  77. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79–86.

    Article  Google Scholar 

  78. Gagliardi AR, Green C, Dunn S, Grace SL, Khanlou N, Stewart DE. How do and could clinical guidelines support patient-centred care for women: Content analysis of guidelines. PLoS ONE. 2019;14(11):e0224507.

    Article  Google Scholar 

  79. Ngo-Metzger Q, August KJ, Srinivasan M, Liao S, Meyskens FL. End-of-Life care: guidelines for patient-centered communication. Am Fam Physician. 2008;77(2):167–74.

    Google Scholar 

  80. Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000;39(1):49–59.

    Article  Google Scholar 

  81. Chan CMH, Azman WA. Attitudes and role orientations on doctor-patient fit and patient satisfaction in cancer care. Singapore Med J. 2012;53(1):52–6.

    Google Scholar 

  82. Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Phys Ther. 2010;90(8):1099–110.

    Article  Google Scholar 

  83. Pirhonen L, Gyllensten H, Olofsson EH, Fors A, Ali L, Ekman I, et al. The cost-effectiveness of person-centred care provided to patients with chronic heart failure and/or chronic obstructive pulmonary disease. Health Policy OPEN. 2020;1(1): 100005.

    Article  Google Scholar 

  84. Stewart M, Ryan BL, Bodea C. Is patient-centred care associated with lower diagnostic costs? Healthc Policy Polit Sante. 2011;6(4):27–31.

    Google Scholar 

  85. Abiola T, Udofia O, Abdullahi A. Patient-doctor relationship: The practice orientation of doctors in Kano. Niger J Clin Pract. 2014;17(2):241.

    Article  Google Scholar 

  86. Ishikawa H, Eto M, Kitamura K, Kiuchi T. Resident physicians’ attitudes and confidence in communicating with patients: A pilot study at a Japanese university hospital. Patient Educ Couns. 2014;96(3):361–6.

    Article  Google Scholar 

  87. Shaw WS, Woiszwillo MJ, Krupat E. Further validation of the Patient-Practitioner Orientation Scale (PPOS) from recorded visits for back pain. Patient Educ Couns. 2012;89(2):288–91.

    Article  Google Scholar 

  88. Pereira CMAS, Amaral CFS, Ribeiro MMF, Paro HBMS, Pinto RMC, Reis LET, et al. Cross-cultural validation of the Patient-Practitioner Orientation Scale (PPOS). Patient Educ Couns. 2013;91(1):37–43.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Kent Murnaghen for his contributions in creating the search strategy used in this systematic review.

Funding

The authors did not receive any funding for conducting this systematic review.

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All authors (GB, BC, JY, KS, JZ) contributed to the conception and design, interpretation of data, drafting, revision, and final approval of the version of the manuscript to be published. GB and BC independently screened, abstracted, and analyzed the relevant data. All authors read and approved the final manuscript.

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Correspondence to Geronimo Bejarano.

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The authors declare no activities, work, or financial relationships that could appear to influence this systematic review.

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Supplementary Information

Additional file 1:

 Appendix 1. PRISMA 2020 Table. Appendix 2. Medline, CINAHL, andEmbase search strategy. Appendix 3. Modified Downs andBlack checklist. Appendix 4. Risk of Bias table.

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Bejarano, G., Csiernik, B., Young, J.J. et al. Healthcare students’ attitudes towards patient centred care: a systematic review with meta-analysis. BMC Med Educ 22, 324 (2022). https://doi.org/10.1186/s12909-022-03371-1

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Keywords

  • Patient centred
  • Students
  • Patient-practitioner orientation scale