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General practice / Family practice
Research
Definition of whole person care in general practice in the English language literature: a systematic review
  1. Hayley Thomas1,
  2. Geoffrey Mitchell1,
  3. Justin Rich1,
  4. Megan Best2
  1. 1 Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
  2. 2 Psycho-Oncology Co-operative Research Group, Sydney Health Ethics, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Hayley Thomas; h.thomas{at}uq.edu.au

Abstract

Objectives The importance of ‘whole person’ or ‘holistic’ care is widely recognised, particularly with an increasing prevalence of chronic multimorbidity internationally. This approach to care is a defining feature of general practice. However, its precise meaning remains ambiguous. We aimed to determine how the term ‘whole person’ care is understood by general practitioners (GPs), and whether it is synonymous with ‘[w]holistic’ and ‘biopsychosocial’ care.

Design Systematic literature review.

Methods MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Proquest Dissertations and Theses, Science.gov (Health and Medicine database), Google Scholar and included studies’ reference lists were searched with an unlimited date range. Systematic or literature reviews, original research, theoretical articles or books/book chapters; specific to general practice; relevant to the research question; and published in English were included. Included literature was critically appraised, and data were extracted and analysed using thematic synthesis.

Results Fifty publications were included from 4297 non-duplicate records retrieved. Six themes were identified: a multidimensional, integrated approach; the importance of the therapeutic relationship; acknowledging doctors’ humanity; recognising patients’ individual personhood; viewing health as more than absence of disease; and employing a range of treatment modalities. Whole person, biopsychosocial and holistic terminology were often used interchangeably, but were not synonymous.

Conclusions Whole person, holistic and biopsychosocial terminology are primarily characterised by a multidimensional approach to care and incorporate additional elements described above. Whole person care probably represents the closest representation of the basis for general practice. Health systems aiming to provide whole person care need to address the challenge of integrating the care of other health professionals, and maintaining the patient–doctor relationship central to the themes identified. Further research is required to clarify the representativeness of the findings, and the relative importance GPs’ assign to each theme.

PROSPERO registration number CRD42017058824.

  • whole person care
  • biopsychosocial
  • holistic
  • primary care
  • general practice
  • systematic review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023758

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    Footnotes

    • Contributors HT, MB and GM conceived and designed the original protocol. HT and JR performed the title/abstract screen. HT, MB and GM were involved in screening full-text articles, critical appraisal and data analysis. HT wrote the first draft of the manuscript with MB and GM, and all authors contributed to the subsequent drafts. All authors had full access to all data and HT, MB and GM can take responsibility for the integrity of the data and accuracy of data analysis. GM is the guarantor and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned and registered have been explained.

    • Funding This review is supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training programme.

    • Competing interests HT’s position was funded by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training programme. MB has received funding from the New South Wales Cancer Institute.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.