Framing the Conversation: Institutional Documents and the Construction of Patient-Centered Communication

Abstract

Institutional documents do more than convey information. They frame what patient-centered communication (PCC) means, who counts as a communicative partner, and what forms of interaction are made possible or constrained before any clinical encounter begins. This study examines how PCC is conceptualized, operationalized, and discursively constructed across programmatic materials namely policies, training materials, patient education resources, and program reports within a national public health program. Grounded in organizational communication theory and an extended Person-Centered Care and Communication Continuum (PC4) framework, the study employed summative qualitative content analysis of 30 documents spanning 2020–2025, from the Philippine National Tuberculosis Program's management of multidrug-resistant tuberculosis (MDR-TB). Findings reveal that document types occupy systematically distinct positions along the PC4 continuum, reflecting differential document agency tied to institutional function. Policy documents articulate strong person-centered commitments through rights-based, partnership-oriented language. Training materials translate these into directive provider protocols. Program reports, however, frame PCC as supplementary to technically driven care cascades, rendering communication quality largely invisible in routine monitoring psychosocial. Four cross-cutting themes emerged: rights-based empowerment, cultural sensitivity and multilingual communication, technology-enhanced person-centered care, and support. Of the 31 analytical codes, ten showed no representation across materials, treated as substantive absences signaling what the system has not yet constituted as institutionally relevant.