Article Text

Download PDFPDF
Integrating person-centred care and social justice: a model for practice with larger-bodied patients
  1. Deana Kanagasingam,
  2. Laura Hurd,
  3. Moss Norman
  1. School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr. Deana Kanagasingam, School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada; deana.kanagasingam{at}ubc.ca

Abstract

Person-centred care (PCC) has been touted as a promising paradigm for improving patients’ experiences and outcomes, and the overall therapeutic environment for a range of health conditions, including obesity. While this approach represents an important shift away from a paternalistic and disease‐focused paradigm, we argue that PCC must be explicitly informed by a social justice lens to achieve optimal conditions for health and well-being. We suggest that existing studies on PCC for obesity only go so far in achieving social justice goals as they operate within a biomedical model that by default pathologises excess weight and predetermines patients’ goals as weight loss and/or management, regardless of patients’ embodied experiences and desires. There remains a dearth of empirical research on what social justice-informed PCC looks like in practice with larger patients. This interview study fills a research gap by exploring the perspectives of 1) health practitioners (n=22) who take a critical, social justice-informed approach to weight and 2) larger patients (n=20) served by such practitioners. The research question that informed this paper was: What are the characteristics of social justice-informed PCC that play out in clinical interactions between healthcare practitioners and larger-bodied patients? We identified five themes, namely: 1) Integrating evidence-based practice with compassionate, narrative-based care; 2) Adopting a curious attitude about the patient’s world; 3) Centring patients’ own wisdom and expertise about their conditions; 4) Working within the constraints of the system to advocate for patients to receive equitable care; 5) Collaborating across professions and with community services to address the multifaceted nature of patient health. The findings illustrate that despite participants’ diverse perspectives around weight and health, they shared a commitment to PCC by upholding patient self-determination and addressing weight stigma alongside other systemic factors that affect patient health outcomes.

  • obesity
  • narrative medicine
  • Medical humanities
  • medical ethics/bioethics
  • sociology

Data availability statement

The full data set is not publicly available as this was not a part of the consent process. Deidentified data may be available upon reasonable request to the authors.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

The full data set is not publicly available as this was not a part of the consent process. Deidentified data may be available upon reasonable request to the authors.

View Full Text

Footnotes

  • Contributors DK: conceptualisation (lead); data curation (lead); formal analysis (lead); funding acquisition (lead); investigation (lead); methodology (lead); project administration (lead); writing—original draft (lead); writing-review and editing (lead); guarantor. LH: conceptualisation (supporting); formal analysis (supporting); funding acquisition (supporting); investigation (supporting); methodology (supporting); project administration (supporting); writing—review and editing (supporting). MN: conceptualisation (supporting); formal analysis (supporting); funding acquisition (supporting); investigation (supporting); methodology (supporting); project administration (supporting); writing—review and editing (supporting).

  • Funding During the project, the first author was supported by a Doctoral Fellowship from the University of British Columbia (UBC) and a research grant from the School of Kinesiology, UBC for the research, authorship and/or publication of this article.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.