How is power reflected in the patient centred care literature? A critical review of power in the centredness literature through a social science lens

Patient-centredness is a key component of high-quality healthcare. A critical part of centredness is the sharing of power within the practitioner-patient relationship. Yet, there has been little reflection on how power, shared power and empowerment are reflected in healthcare literature about centredness. Our aim was to identify definitions and understanding of power in the healthcare literature on centredness and critically examine these discourses through the framing device of the “faces of power”. A total of 159 papers from a published scoping review on centredness (REF blinded for review) were reviewed for any mention of power. A subset of 46 papers that used the words “power” or “empowerment” were analysed using discourse analysis. Analysis paid detailed attention to the meaning and function of statements in the contexts they occurred to understand taken-for-granted ideas about power in the centredness literature. While power was rarely explicitly defined, ‘sharing power’ was central to the notion of patient centred care. When power was defined it was often conceived as something that clinicians have and can give to patients and then they will make the “right” choice. The literature outlines strategies and consequences of sharing power and barriers and consequences of not sharing power. This work reflects on what is meant when the terms ‘power’ and ‘sharing power’ are used and it aims to start a discussion that goes beyond outcomes, toward reimagining clinician-patient relationships.