Background 

Centredness is the overarching umbrella term to represent person-centred, resident-centred, patient-centred, family-centred and relationship-centred care concepts. Depending on the setting in which care is provided, the term used may vary. For example, patient-centred care is most frequently invoked in acute care settings, whereas in long-term care settings, the terms person-centred, resident-centred and relationship-centred care are more often used. Family-centred care appears most frequently related to the context of obstetrical and critical care.

The need to promote centredness in healthcare, especially in long-term care settings, has been well established in the literature.9 For the purpose of this scoping review, long-term care facilities, often known as nursing or care homes, can be understood as providing living accommodation for people who require on-site delivery of 24 hours, 7 days a week supervised care, including professional health services, personal care and services such as meals, laundry and housekeeping.10 While not all residents of long-term care facilities are older adults, only about 6.7% of Canadian residential long-term care residents are younger than 65 years.11 Individuals living in long-term care facilities require complex care as most have considerable needs related to multiple medical diagnoses and over half of residents have a diagnosis of an age-related dementia.12

With an increase in the ageing population, there is a growing demand for long-term care services for older adults. However, there is a mounting concern that people living in long-term care facilities are not receiving the quality of care they require and as a result are socially isolated, helpless and bored.13 14 People living in long-term care facilities are often reported to have lower quality of life and poorer health outcomes than those living in the community.13 Many long-term care facilities operate using the traditional medical model where people are often medicalised, subjected to ageism and have little or no power and control over their lives.15 16

Several studies have suggested the need for culture change in long-term care facilities by shifting away from the medical model and de-institutionalising the environment and care practices.13 15 17 Person-centred care has been recommended as the foundation for culture change in long-term care facilities and for the promotion of a best practice approach in providing quality care.17 Healthcare providers are encouraged to centre on the people they provide care for by promoting their independence and their rights to make decisions and choices related to their day-to-day activities. In particular, person-centred practices that focus on the person rather than the disease are crucial in the care of people living with dementia.13 18 19 Although the concepts of centredness have been readily adopted by many long-term care facilities, what constitutes centredness is often vague and lacks conceptual clarity and definition. Previous studies have reported confusion around the implementation of some of these concepts.13 20 Frequently, the use of person-centred, resident-centred, relationship-centred and family-centred care are used interchangeably or are reported side-by-side.7 This mixing of terminology fails to acknowledge theoretical, philosophical or conceptual differences that may exist among the terms or even if they result in the same outcomes. As such, there is a muddling of the concepts that does little to advance knowledge and best practices. Therefore, it is imperative to examine the meaning of centredness in the context of long-term care. The objectives of this scoping review are (1) to map the existing literature examining the use of ‘centredness’ terms in the context of long-term care; (2) to determine the defining conceptual features and outcomes of each and (3) to identify gaps for future research.

Methods/design

After considering the various systematic approaches to reviewing and assessing published literature, we decided to use the scoping review method in order to most broadly capture the current discourse on this topic. Scoping reviews studies are undertaken to map the range of evidence in a field of study and may help to point out gaps in the existing literature.21 However, unlike systematic reviews or meta-analyses, the quality of included studies is not evaluated.22

To assist in the development of the protocol for the scoping review, we used Arksey and O’Malley’s23 framework and have incorporated the improvements put forth by Levac and colleagues22 to improve the rigour and consistency of the process. This framework proposes five mandatory stages which are outlined below. An optional sixth stage (consultation with stakeholders) is proposed, but our current study has not examined this due to the nascent stage of the project. Once the review is complete, we fully intend to engage in an active knowledge translation stage which will involve consultation with stakeholders.

Patient and public involvement

In terms of stakeholder involvement and consultation, it may be helpful to note that this research question was born out an agenda of research involving collaboration between groups of clinicians, policy makers and academics, but public and patients were not expressly consulted in the development of this protocol.

Stage 1: identifying the research questions

In order to guide the scoping study, broad research questions were developed, and a clearly articulated scope of inquiry was outlined.22 As such, we considered the target population, context and centredness frameworks in defining our questions, and subsequent search strategy (see table 1).

As our intention is to compare and contrast common ‘centredness’ terms used in long-term care and to provide clarification of the definitions and conceptual boundaries between these terms, we chose the following specific questions to guide our review:

1. What are the defining attributes, conceptual boundaries and theoretical underpinnings of each centredness term in long-term care facilities?

2. For what purposes have centredness directed models of care been used in the context of long-term care facilities?

3. What types of study designs have been used to examine centredness in long-term care facilities?

4. What outcomes related to centredness in long-term care facilities have been reported or evaluated and how were they measured?

Stage 2: identifying relevant studies

As a means to ensure comprehensiveness in identifying primary studies and other relevant literature,23 the team iteratively decided on criteria for eligibility, databases to search and key terms to be used in the search strategy. While as previously noted, we recognise not all residents of long-term care facilities are older adults (eg, 65 years and older), in many countries, separate facilities are provided for children and young adults; the idea being that while their healthcare needs may be similar, their social and recreational needs are not.24 Such facilities that specialise in the care of children and young adults are not the focus of this review.

Stage 3: study selection

Study selection will occur in a two-step process. First, the titles and abstracts of all papers retrieved by the searches will be screened by individual reviewers on the team, to determine eligibility based on the inclusion and exclusion criteria. In order to ensure the screening criteria were being equally applied, the four reviewers will independently assess the first 50 articles and then meet to discuss their conclusions.

The second stage of the process will involve a full-text review for eligibility by two authors (GT, SM, BA, CS), with disagreements resolved through discussion until a consensus is reached. A flow diagram detailing article selection process will be displayed to enhance the transparency about the search and screening process.

Stage 4: charting the data

During this stage, data will be extracted from the included studies, using a data extraction form jointly developed by the research team.22 Data to be extracted will differ depending on the type of publication but will include standard bibliographic information such as author, title, year of publication and type of evidence as well as definition of ‘centredness’ and use of theory. A summary of key theoretical and philosophical foundations will be recorded. For primary studies, data will also include study objectives, sample size, study design, outcomes, outcome measures and key findings.25 A preliminary data extraction form is provided in table 2.

Following the recommendations of Levac and colleagues,22 the data extraction form will be trialled with the first 10 studies to ensure data extraction is consistent with the research questions and purpose, and that the researchers are consistent in their approach. Data will be entered into Microsoft Excel.

Stage 5: collating, summarising and reporting the results

The strength of the scoping review process is in its ability capture the complexity of data in an area and to present an overview that also considers the implications for practice, policy and research.26 Levac and colleagues22 advocate for a rigorous approach to analysis that involves both a descriptive numerical summary and a thematic analysis of the data. This approach has been supported by others as a means of strengthening the scoping review methodology.21 While this stage of our project is still a work in progress, we have the qualitative expertise on our team to use the thematic approach described by Braun and Clarke27 to capture the broad themes in the data. We anticipate using text and visual approaches to presenting our data. More specifically, findings will be displayed through the development of a conceptual map outlining the meanings of each term, the purpose for which they have been used, the theoretical and philosophical underpinnings and the various outcome measures that have been used for each.

Ethics and dissemination

All data generated from the review will be stored on password-protected computers. Dissemination plans will follow a targeted and tailored approach, as advocated by the Canadian Health Services Research Foundation Model.28 Publication of findings in peer-reviewed journals and at national and international conferences will be pursued. Findings relevant to stakeholders such as long-term care administrators, clinicians and policy planners will be presented through webinars, face-to-face meetings and other social media tools.