A comparison of patients' and dietitians' perceptions of patient-centred care: A cross-sectional survey.

The aim of this study was to compare patients' and dietitians' perceptions of patient-centred care (PCC) in dietetic practice. Participants were as follows: (a) adult patients who had attended ≥1 individual dietetic consultation with an Accredited Practicing Dietitian (APD) working in primary care; and (b) APDs with experience working in primary care. A cross-sectional survey was undertaken using a patient- and dietitian-reported inventory to measure PCC in dietetic practice. The inventory comprised of five previously validated scales: The Communication Assessment Tool; the 9-item Shared Decision-Making Questionnaire; the Patient-Doctor Depth of Relationship Scale; the Schmidt Perception of Nursing Care Scale-Seeing the Individual Patient sub-scale; and the Person-Centred Practice Inventory-Staff -Providing Holistic Care sub-scale. Descriptive statistics were used to analyse participant characteristics and to compute total scores for the five scales. The Mann-Whitney U test was used to compare median scores between patients and dietitians. One-hundred and thirty-three patients and 180 dietitians completed the survey. Patients reported significantly higher scores compared to dietitians for "shared decision-making" (P = 0.004), but significantly lower scores for "providing holistic and individualized care" (P = 0.005), "knowing the patient/dietitian" (P = 0.001) and "caring patient-dietitian relationships" (P =0.009). This study highlighted potentially important differences between patients' and dietitians' perceptions of PCC and identified key aspects of dietetic care requiring practice improvements. Strategies are needed to bridge gaps between dietitians' and patients' perceptions and enhance PCC in dietetic practice. These findings suggest that dietitians should focus on individualizing nutrition care, gaining a holistic understanding of their patients and knowing/understanding each patient.

Sladdin I ，Ball L ，Gillespie BM ，Chaboyer W ... -  《-》

Development and psychometric testing of an inventory to measure patient-centred care in dietetic practice - dietitian version.

The lack of a valid instrument to measure patient-centred care (PCC) in dietetic practice makes it challenging to evaluate how patient-centred dietitians are. The present study aimed to develop and psychometrically test a dietitian-reported inventory to measure PCC in dietetic practice. The inventory was compiled based on a literature review of existing validated scales that measured the dimensions of PCC. Next, the inventory was distributed as a cross-sectional survey to 180 Australian Accredited Practicing Dietitians who worked in primary care. Exploratory factor analysis was performed using principal factor analysis with Promax rotation. Cronbach's alpha (criteria ≥0.80), inter-item correlations and corrected item-total correlations (criteria 0.30-0.70) were computed to evaluate the internal consistency of each scale. Five factors were extracted accounting for 56.9% of the variance. Most variables had strong loadings on only one factor. Factors were labelled as: shared decision-making; holistic and individualised care; patient-dietitian communication; knowing the patient; and caring patient-dietitian relationships. Cronbach's alpha was 0.94 for the total inventory and ranged from 0.73 to 0.91 for the individual factors. Inter-item correlations and corrected item-total correlations mostly fell in the desired range. The present study offers a preliminary, conceptually grounded dietitian-reported inventory, which is the first instrument developed and tested to measure PCC in dietetic practice. These findings illustrate the underlying factor structure of the inventory and support the reliability of the scales. With further testing, this inventory may provide useful to clinicians and researchers working to better understand and improve dietetic practice.

Sladdin I ，Gillespie BM ，Ball L ，Chaboyer W ... -  《-》

Dietitians' perspectives of the barriers and enablers to delivering patient-centred care.

Patient-centred care (PCC) is widely recognised as being important with respect to the delivery of quality health care. However, limited research has explored PCC in the dietetic context. In particular, dietitians' views of the barriers and enablers to delivering a patient-centred approach have not been investigated. Therefore, the present study aimed to explore primary care dietitians' perspectives of the barriers and enablers to delivering PCC. The present study was situated in a constructivist-interpretivist paradigm and used qualitative methods. Both convenience and snowball sampling were used to recruit Australian Accredited Practising Dietitians (APD) who were working in primary care. Individual semi-structured interviews explored dietitians' perspectives of the barriers and enablers to delivering PCC. Data were analysed thematically. Twelve APDs were interviewed between March and April 2018. Seven themes were discovered: (i) challenges in defining PCC; (ii) valuing PCC; (iii) enacting PCC; (iv) requiring additional education in PCC; (v) evaluating one's own practice; (vi) workplace pressures and constraints; and (vii) keeping up with expectations. These findings suggest that: (i) the meaning of PCC in dietetics should be clarified to ensure it is being practiced consistently; (ii) undergraduate curricula require a greater emphasis on PCC so that dietitians graduate with the necessary knowledge and skills; (iii) there is a need for more professional development training to facilitate uptake of PCC in practice; and (iv) quantitative measurement of PCC using validated instruments is needed to evaluate PCC in the dietetic setting. Addressing some of these factors may assist dietitians to adopt these practices.

Levey R ，Ball L ，Chaboyer W ，Sladdin I ... -  《-》

Patients' perceptions and experiences of patient-centred care in dietetic consultations.

Patient-centred care (PCC) is essential to quality healthcare. However, there is a paucity of research on PCC in dietetics, particularly regarding patients' experiences and perspectives of PCC. We aimed to enhance our understanding of PCC in dietetics by exploring patients' perceptions and experiences of PCC in individual dietetic consultations. The present study used qualitative methods, situated in a constructivist-interpretivist paradigm. Maximum variation purposive sampling was used to recruit English speaking adult participants who had participated in ≥1 dietetic consultations for nutrition care. Individual semi-structured interviews explored participants' perceptions and experiences of PCC in dietetic consultations. Data were analysed thematically. Eleven patients were interviewed between September and November 2016. Four overarching themes emerged: (i) fostering and maintaining caring relationships; (ii) delivering individualised care; (iii) enabling patient involvement; and (iv) taking control of one's own health. PCC is important to patients. Thus, there is opportunity for dietitians to enhance the care they provide by adopting patient-centred practices. As the first study of its kind, these findings can inform future dietetic practice, education and research by contributing patients' perspectives of PCC. By understanding patients' unique needs and preferences, dietitians can better align their practice with a patient-centred approach. Furthermore, these findings are useful for informing future dietetic research and education.

Sladdin I ，Chaboyer W ，Ball L 《-》

Development and psychometric testing of a patient-reported inventory to measure patient-centred care in dietetic practice.

Sladdin I ，Chaboyer W ，Ball L ，Gillespie BM ... -  《-》