Cultural traits of patient-centeredness : a comparison between American and Italian clinical consultations

Aim: To examine the effect that culture has on shaping the concept and practice of patient-centered care. Specifically, we examined how patient-centeredness is understood and enacted in American and Italian cultures. Participants: Participants were drawn, on a voluntary basis, from two interdisciplinary groups of clinicians, experts in communication at: Children’s Hospital, Boston, affiliated with Harvard Medical School, USA and San Paolo Hospital, affiliated with Milan University, Italy. Design: An action research methodology was employed. The American and Italian participants independently wrote a patient-centered dialogue between a physician and a patient in response to the same scenario. The dialogues were then translated and exchanged. The two groups independently commented on the patient-centeredness of each other's dialogue through a written survey, and their respective comments were then shared by international videoconference. Transcript of the videoconference was analyzed via content analysis. The participants’ opinion about the study was collected through an evaluation questionnaire. Results: Through content analysis, three themes emerged as conceptual components of patient-centeredness: "Exploring the Patient’s Illness experience", "Respecting the Patient’s Autonomy" and "Handling the Patient’s Emotions". "Exploring the Patient’s Illness Experience" and "Handling the Patient’s Emotions" were identified as core components by both Americans and Italians, but were expressed differently in their respective dialogues. "Respecting the Patient's Autonomy" was recognized as a component of patient-centered care by the Americans but not by the Italians who demonstrated a more implicitly paternalistic approach. Participants reported an increased self-awareness and highlighted the usefulness of each other's feedback to uncover cultural assumptions of patient-centered care. Conclusions: Results suggest that the concept and practice of patient-centered care is partly culture-bound.