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Assessing collaborative efforts of making care fit for each patient: A systematic review

Paskins, Zoe

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For too many people, their care plans are designed without fully accounting for who they are, the lives they live, what matters to them or what they aspire to achieve. We aimed to summarize instruments capable of measuring dimensions of patient–clinician collaboration to make care fit.

We systematically searched several databases (Medline, Embase, Cochrane, Scopus and Web of Science) from inception to September 2021 for studies using quantitative measures to assess, evaluate or rate the work of making care fit by any participant in real-life clinical encounters. Eligibility was assessed in duplicate. After extracting all items from relevant instruments, we coded them deductively on dimensions relevant to making care fit (as presented in a recent Making Care Fit Manifesto), and inductively on the main action described.

We included 189 papers, mostly from North America (N = 83, 44%) and in the context of primary care (N = 54, 29%). Half of the papers (N = 88, 47%) were published in the last 5 years. We found 1243 relevant items to assess efforts of making care fit, included within 151 instruments. Most items related to the dimensions ‘Patient-clinician collaboration: content’ (N = 396, 32%) and ‘Patient-clinician collaboration: manner’ (N = 382, 31%) and the least related to ‘Ongoing and iterative process’ (N = 22, 2%) and in ‘Minimally disruptive of patient lives’ (N = 29, 2%). The items referred to 27 specific actions. Most items referred to ‘Informing’ (N = 308, 25%) and ‘Exploring’ (N = 93, 8%), the fewest items referred to ‘Following up’, ‘Comforting’ and ‘Praising’ (each N = 3, 0.2%).

Measures of the work that patients and clinicians do together to make care fit focus heavily on the content of their collaborations, particularly on exchanging information. Other dimensions and actions previously identified as crucial to making care fit are assessed infrequently or not at all. The breadth of extant measures of making care fit and the lack of appropriate measures of this key construct limit both the assessment and the successful implementation of efforts to improve patient care.

Patient Contribution
Patients and caregivers from the ‘Making care fit Collaborative’ were involved in drafting the dimensions relevant to patient–clinician collaboration.


Paskins, Z., Kunneman, M., Gravholt, D., Hartasanchez, S. A., Gionfriddo, M. R., Prokop, L. J., …Montori, V. M. (2023). Assessing collaborative efforts of making care fit for each patient: A systematic review. Health Expectations, 26(4), 1391-1403.

Journal Article Type Article
Acceptance Date Mar 26, 2023
Online Publication Date Apr 16, 2023
Publication Date Mar 27, 2023
Publicly Available Date May 30, 2023
Journal Health Expectations
Print ISSN 1369-6513
Electronic ISSN 1369-7625
Publisher Wiley
Volume 26
Issue 4
Pages 1391-1403
Keywords making care fit; medical decision making; patient involvement; patient-clinician communication; shared decision making
Publisher URL


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