The need for epistemic reciprocity in person-centred care : a multi-method qualitative study

Dell’Olio, Myriam

Medical sciences
September 2021

Thesis or dissertation

© 2021 Myriam Dell’Olio. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Background – Person-centred care is a policy priority in the United Kingdom, yet people with long-term conditions report a deficiency in person-centred healthcare relative to their wishes and expectations. Whilst several factors contribute to this problem, recent work recognises a persisting reported failure of healthcare staff to give adequate credence to patients’ knowledge work, which may contribute to worsening person-centred care. Therefore, I set out to answer the following research question: “What does an analysis of the knowledge work done by adults with chronic conditions in the context of their healthcare experiences tell us about changes needed to strengthen person-centred primary care?”
Methods – I adopted a multi-method qualitative design. This included a meta-ethnography of published research followed by primary data collection through individual interviews (analysed through interpretive phenomenological analysis) and focus groups (analysed through thematic analysis), which I integrated through an approach that focused on their complementarity.
Results – My empirical research described that the participants’ knowledge work involves information seeking, experimentation and reflection, and leads to acquired experiential knowledge that is exclusive, unique and functional. The participants brought this knowledge to primary care settings to negotiate care, and successful negotiations unfolded through moments of active exploration, amplified listening, and reciprocal inquiry.
Discussion and conclusions – The person-centred clinical consultation is defined as a negotiated exploration of the patient’s complex experience, grounded in both the patient’s and the doctor’s knowledge work, and that values and enhances the patient’s learning journey. I therefore propose a new concept, epistemic reciprocity, as a principle that guides the clinical negotiation and fosters the co-creation of new knowledge of patient experience and need through the interactive knowledge work of patient and doctor. In considering epistemic reciprocity as a core component of successful person-centred care, I describe the implications for future education, professional practice, and research.

Hull York Medical School, The University of Hull and the University of York
Reeve, Joanne Lucy; Whybrow, Paul; Seymour, Julie
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