The study, led by Heejung Kim of Woosuk University and Chungnam National University together with colleagues in South Korea and Vietnam, updates and extends a 2018 umbrella review that had synthesized patient- and family-centered care evidence across heterogeneous contexts but had never systematically compared care elements, delivery modalities, and outcomes across settings. To fill that gap, the team searched six databases, including PubMed/MEDLINE, Embase, CINAHL, PsycINFO, the Cochrane Library, and Google Scholar, for systematic reviews published between September 2017 and May 2026. Three reviewers independently screened the records, extracted data, and appraised methodological quality, and the protocol was prospectively registered on PROSPERO in July 2024. Because the underlying interventions varied so widely in their components, comparators, and measured outcomes, the authors synthesized the evidence narratively, sorting it by care setting, care element, delivery modality, and stakeholder-related outcomes.

The scale of the synthesis alone is striking. Of the 63 systematic reviews included, 21 addressed acute care, 35 focused on community care, and 7 examined long-term care. That distribution is itself informative: community care, where chronic disease management, home-based services, and outpatient programs dominate, has generated by far the richest research base for patient- and family-centered approaches, while long-term care, home to some of the most vulnerable populations in any health system, remains comparatively under-studied. The imbalance hints at where the scientific spotlight has fallen and where it has not, and it frames one of the review’s central warnings that evidence in some settings is far thinner than the popularity of the concept might suggest.

In acute care settings, spanning intensive care units, emergency departments, neonatal units, and general hospital wards, the dominant care elements were family involvement and family education. Hospitals, in other words, have concentrated on opening their doors to relatives: allowing family presence during rounds and procedures, keeping families informed, and equipping them to participate in care decisions and recovery activities. But the outcomes measured in this setting were predominantly short-term, reflecting the episodic nature of hospitalization. Length of stay, immediate patient or family satisfaction, and short-window clinical indicators featured heavily, while the question of whether family-centered practices in the hospital translate into durable benefits after discharge was largely left unanswered by the available reviews.

Community care presented the broadest spectrum of both care elements and outcomes. Here the reviews captured effects on patient self-efficacy, autonomy, quality of life, and a wide range of caregiver-related outcomes, alongside clinical measures such as glycated hemoglobin, blood pressure, and lipid profiles in chronic disease management. The breadth makes sense: community care is where patients live with their conditions over years rather than days, so success is measured not by survival through an admission but by whether people can manage their own health, maintain independence, and sustain quality of life. Families in these settings are not supplementary but central, often carrying the daily workload of medication management, monitoring, and lifestyle support, and the evidence base reflects that reality by tracking caregiver burden, capability, and wellbeing as outcomes in their own right.

Long-term care told a different story again. In nursing homes and residential facilities, the most prominent care elements were patient environmental support and healthcare-provider education and training. That is, interventions focused on shaping the physical and social environment around residents and on teaching staff how to deliver person-centered and family-centered practices, rather than on engaging families directly. Tellingly, family outcomes were less frequently reported in this setting, a gap the review highlights as a significant blind spot. Families of residents in long-term care are often deeply involved in advocacy, decision-making, and emotional support, yet the research has rarely asked how these interventions affect them, leaving a whole dimension of stakeholder experience largely unmeasured.

Delivery modality emerged as another axis of striking unevenness. In-person delivery predominated across all three settings, which is unsurprising given the hands-on nature of much nursing and medical care. However, hybrid and digital approaches were concentrated mainly in community care, where telehealth, remote monitoring, mobile applications, and blended models of virtual and face-to-face contact have expanded rapidly, particularly since the pandemic era accelerated their adoption. The authors suggest that digital and hybrid modalities may complement patient- and family-centered care by supporting communication, continuity, accessibility, and coordination, but they are careful to note that the evidence for these approaches remains concentrated in community settings, leaving acute and long-term care comparatively unexplored territory for digitally mediated family engagement.

Perhaps the most conceptually important finding concerns two elements that appeared across all settings yet were never consistently represented: shared decision-making and dignity care. Shared decision-making, the structured process by which clinicians and patients jointly weigh options and reach choices aligned with patient values, is often described as the intellectual core of patient-centered care. Dignity care, which attends to respect, privacy, and the preservation of personhood, is its ethical counterpart. That both were identified everywhere but standardized nowhere suggests that the field’s most fundamental commitments are also its most inconsistently operationalized. Interventions may bear the patient-centered label while measuring very different things, and the review’s narrative synthesis, forced by heterogeneity in intervention components, comparators, and outcomes, is itself a symptom of a field that has grown faster than its shared definitions.

The authors’ conclusion is therefore a reframing rather than an endorsement of any single recipe. Patient- and family-centered care, they argue, should be understood not as a single intervention model that can be rolled out identically everywhere, but as a context-sensitive care delivery strategy whose components must be selected and weighted according to the setting. In the hospital, that means designing for family presence and education while pushing research beyond short-term outcomes; in the community, it means leveraging the broadest toolkit, including digital and hybrid delivery, to build self-efficacy, autonomy, and caregiver resilience; in long-term care, it means strengthening environmental support and provider training while finally bringing families into the outcome framework. The review also issues a forward-looking agenda: future research should prioritize approaches that promote autonomy, dignity, and meaningful participation in care and decision-making across all settings, rather than continuing to accumulate heterogeneous studies that resist comparison.

For clinicians, policymakers, and health system leaders, the practical message is that importing a patient- and family-centered care package from one setting into another without adaptation is unlikely to succeed. The evidence assembled here, drawn from reviews spanning neonatal intensive care to dementia care and chronic disease management, shows that the same philosophy must be engineered differently for a three-day hospital stay, a decade of diabetes self-management, or the final years in a residential facility. As health systems worldwide grapple with aging populations, rising chronic disease burdens, and workforce shortages, the review offers both a map of what has been built and a candid account of where the foundations are still thin, particularly in long-term care and in the consistent measurement of what matters most to the patients and families the model was designed to serve.

Subject of Research: Patient- and family-centered care elements, delivery modalities, and stakeholder outcomes across acute, community, and long-term care settings

Article Title: Patient- and family-centered care across acute, community, and long-term care settings: an updated umbrella review of care elements, delivery modalities, and stakeholder-related outcomes

Article References: Kim, H., Park, M., Kim, J., Doan, T. T.-T., & Giap, T.-T.-T. (2026). Patient- and family-centered care across acute, community, and long-term care settings: an updated umbrella review of care elements, delivery modalities, and stakeholder-related outcomes. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15699-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15699-1

Keywords: patient-centered care, family-centered care, umbrella review, acute care, community care, long-term care, shared decision-making, dignity care, digital health, caregiver outcomes, health services research, systematic review