the empathetic healthcare way

Person Centred Care

In Person-Centred Care in the centre are “patient’s goals, capabilities and expectations” and the patient is an equal partner together with health care professionals in the decision-making process concerning their care.

This idea does not imply that patients and professionals take on the same roles and responsibilities as in a negotiation between equals. The fundamental equality and asymmetry between patient and professional implies that their relationship cannot be a matter of a one-way exercise of power, but neither a symmetrical exchange of information. Establishing a partnership requires an active involvement from both parties, but from different starting points and with different prerequisites. The professional is an expert in medicine, rehabilitation, care etc. and the patient is an expert on their own life, fillings and desires. Person-centred care (PCC) addresses the importance of knowing the person behind the patient. There are many centres in Europe and the US where PCC is developed. One of the most prominent is the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC model consists of three essential ‘routines’ to initiate, integrate and safeguard person-centred care in daily clinical practice [3]:

  1. Patient narrative. Initiate a partnership by eliciting the patient narrative - a sick person’s account of their illness, symptoms and their impact on their life. It captures the person’s suffering in the context of their everyday life, as an equal addition to medical narratives that reflect the process of diagnosing and treating the disease.
  2. Partnership. Work the partnership by means of shared decision making, so that professionals, patients and very often their relatives all work together to achieve commonly agreed goals.
  3. Documentation. Safeguard the partnership by documenting the narrative in the form of patient preferences and values, as well as involvement in care and treatment decision making.

These routines lead to jointly agreed care plan which have to embrace[3]:

  • clinical tasks to be undertaken by the professionals and
  • everyday goals undertaken by the patient/relatives
Key routines lead to care plan

Characteristics

Person-Centred Care (PCC) means a step forward from well-established approach called Patient-Centred Care. The Picker Institute, identified eight characteristics of care as the most important indicators of Patient-Centred Care[1]:

  1. respect for the patient’s values, preferences, and expressed needs
  2. coordinated and integrated care
  3. clear, high-quality information and education for the patient and family
  4. physical comfort, including pain management
  5. emotional support and alleviation of fear and anxiety
  6. involvement of family members and friends, as appropriate
  7. continuity, including through care-site transitions
  8. access to care.

The most important omission in the list is partnership between a patient, their family and healthcare professionals. Thus, Person-Centred Care is shift from a model of care based on diagnoses and one side physician judgement to an approach based on a contractual agreement between a patient, their family and medical professionals. PCC involves the patient as an active partner in care and the decision-making process. Patients and health care professionals jointly develop a health plan based on the patient´s illness history which identifies personal resources and opportunities in the home and social network as well as potential barriers. Identified resources together with medical examinations and bio-markers form the foundation for elaborating the jointly agreed care plan [2]. In Patient-Centred Care a patient is in the centre of the care process but is not an equal partner in their own care and treatment.

Questions identifying a person-centred care

when most of the answers to the following questions are positive than one can consider that delivered care is consistent with person-centred care approach [2][3][4][5]:

# Question
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Your compliance result: 1 / 13

 

Bibliography

  1. Barry, Michael J., and Susan Edgman-Levitan. 2012. Shared Decision Making — The Pinnacle of Patient-Centered Care. New England Journal of Medicine 366: 780–781. doi.org/10.1056/NEJMp1109283.
  2. Ekman, Inger, Karl Swedberg, Charles Taft, Anders Lindseth, Astrid Norberg, Eva Brink, Jane Carlsson, et al. 2011. Person-Centered Care — Ready for Prime Time. European Journal of Cardiovascular Nursing 10: 248–251. doi.org/10.1016/j.ejcnurse.2011.06.008.
  3. Britten, Nicky, Lucy Moore, Doris Lydahl, Oncel Naldemirci, Mark Elam, and Axel Wolf. 2017. Elaboration of the Gothenburg model of person-centred care. Health Expectations 20: 407–418. doi.org/10.1111/hex.12468.
  4. Ahmad, Nahid, Jo Ellins, Holly Krelle, and Michael Lawrie. 2014. Person-centred care: from ideas to action. Health Foundation.
  5. Edvardsson, David, P. O. Sandman, and Lena Borell. 2014. Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics 26: 1171–1179. doi.org/10.1017/S1041610214000258.
  6. Olsson, Lars-Eric, Elisabeth Hansson, Inger Ekman, and Jón Karlsson. 2009. A cost-effectiveness study of a patient-centred integrated care pathway. Journal of Advanced Nursing 65: 1626–1635. doi.org/10.1111/j.1365-2648.2009.05017.x.
  7. Feldthusen, C, A Grimby-Ekman, H Forsblad-d’Elia, L Jacobsson, and K Mannerkorpi. 2016. Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: A longitudinal study. Journal of Rehabilitation Medicine 48: 469–476. doi.org/10.2340/16501977-2090.
  8. Brännström, Margareta, and Kurt Boman. 2014. Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study: PREFER: a randomized controlled study. European Journal of Heart Failure 16: 1142–1151. doi.org/10.1002/ejhf.151.
  9. Koinberg, Ingalill, Elisabeth Hansson Olofsson, Eric Carlström, and Lars-Eric Olsson. 2018. Impact of a person-centered intervention for patients with head and neck cancer: a qualitative exploration. BMC Nursing 17: 48. doi.org/10.1186/s12912-018-0319-6.
  10. Fossey, Jane, Clive Ballard, Edmund Juszczak, Ian James, Nicola Alder, Robin Jacoby, and Robert Howard. 2006. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ 332: 756–761. doi.org/10.1136/bmj.38782.575868.7C.
  11. Arvidsdotter, Tina, Bertil Marklund, Charles Taft, and Sven Kylén. 2015. Quality of life, sense of coherence and experiences with three different treatments in patients with psychological distress in primary care: a mixed-methods study. BMC Complementary and Alternative Medicine 15: 132. doi.org/10.1186/s12906-015-0654-z.
  12. Thompson, D R, and A M Clark. 2009. Cardiac rehabilitation: into the future. Heart 95: 1897–1900. doi.org/10.1136/hrt.2009.173732.
  13. Clark, Alexander M., Lisa Hartling, Ben Vandermeer, Sue L. Lissel, and Finlay A. McAlister. 2007. Secondary prevention programmes for coronary heart disease: a meta-regression showing the merits of shorter, generalist, primary care-based interventions. European Journal of Cardiovascular Prevention & Rehabilitation 14: 538–546. doi.org/10.1097/HJR.0b013e328013f11a.

Authors

Roman Lewandowski, person-centred-care researcher
Roman Lewandowski, PhD
Researcher focused on healthcare sciences, devoted to PCC research; CEO of the Voivodeship Rehabilitation Hospital for Children in Ameryka, Poland; Assistant Professor at University of Social Sciences, Management Faculty. Roman participates in several European research programmes facilitating the development of PCC approach (://costcares.eu). He is the deputy editor-in-chief of the Journal of Health Study and Medicine.
Jędrzej Lewandowski, person-centred-care implementator
Jędrzej Lewandowski
Software architect and medical student. Jędrzej develops two systems aimed at enabling PCC using IT advancements.