Patient-centered care for addictions treatment: findings from a scoping review

Background and Aims: Despite ongoing efforts aimed to improve treatment engagement for people with problematic substance use, evidence shows modest rates of treatment uptake and retention as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that may strengthen the responsiveness of addiction treatment to the client’s unique needs. PCC includes four core dimensions: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliances. This scoping review aimed to explore how PCC has been implemented, defined and measured among people with problematic substance use.

Methods: Following the iterative stages of the Arksey and O’Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people with problematic substance use and implemented and/or measured PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and directed content analysis were performed on extracted data.

Findings: One-hundred and forty-five references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent dimension of PCC (69%); consistently defined by trust, empathy and non-judgment. When quantitatively measured, a therapeutic alliance was positively associated with treatment engagement and substance use outcomes. Shared decision-making was identified in 47 (32%) references and included clinical techniques aimed to increase client autonomy in treatment planning.

Conclusions: Enhancing the therapeutic alliance between clients and addictions treatment providers may improve engagement and substance use outcomes. Strategies for increasing shared decision-making warrant further investigation given their potential to improve in-treatment processes (e.g., client-provider communications, treatment satisfaction). This review contributes to evidence that informs an operationalization of PCC for people with problematic substance use. Such operationalization is essential to establish clinical tools and strategies that can support the implementation and testing of PCC.