Patient Centredness, Values, Equity and Sustainability: Professional, Organizational and Institutional Implications

The concept of “patient centredness”, or “patient-centred care”, has been studied so far as an umbrella term including a variety of declinations, perspectives, and concrete care practices [...]

Improving Patient-Centredness in Endometriosis Care: A Study Protocol for a Prospective Study with a Mixed-Methods Approach

<b><i>Objective:</i></b> Endometriosis is a chronic gynaecologic disease, causing pain and infertility. As there is no definitive cure, patients are subjected to long-term care. This study aimed to improve patient-centred endometriosis care. Patient-centredness of endometriosis care can be evaluated using the validated ENDOCARE questionnaire (ECQ), resulting in centre-specific targets for improvement. To understand how to tackle the targets for improvement as found by the ECQ, focus groups can be organized. <b><i>Design:</i></b> This protocol presents a prospective study with a mixed-methods approach to improve patient-centredness of endometriosis care. The study consists of 5 steps: (1) evaluating current patient-centredness of endometriosis care by using the ECQ, (2) understanding targets for improvement, (3) drafting an improvement plan, (4) implementing improvements, and (5) evaluating the improved patient-centredness of endometriosis care. The final evaluation will be performed 1.5 years after implementing the improvement plan. <b><i>Methods:</i></b> Patient-centredness will be evaluated using the ECQ by inviting women with endometriosis to participate (steps 1 and 5). To investigate step 2, focus groups will be organized. For these focus groups, women with endometriosis are asked to participate until data saturation is achieved. During focus groups, participants are motivated to discuss the found targets for improvement and stimulated to find ways to improve them. The drafting and implementing of the improvement plan (steps 3 and 4) will be organized with the help of health-care providers in close collaboration with the patient organization. To assess whether the implementation of the improvement plan was successful in improving endometriosis care, the results from the ECQ in step 5 will be compared to the results from the ECQ in step 1. Ethical approval was granted by the local Institutional Review Board (Ref 2018.438). <b><i>Setting:</i></b> The study was conducted in the university hospital in the Netherlands. <b><i>Limitations:</i></b> Both patients and health-care providers will be involved in drafting the improvement plan. By making the health-care providers responsible for improving care, the chance of succeeding is optimized. Whether this improvement strategy is successful will be investigated after the implementation of the improvement plan. The improvement plan is clinic specific and can possibly not be extrapolated to other endometriosis clinics. In order to aim to improve patient-centred endometriosis care elsewhere, the complete study protocol should be performed. <b><i>Conclusions:</i></b> This study protocol aimed to investigate focus groups as a strategy to identify possible interventions to improve patient-centred endometriosis care by investigating the underlying causes for poor performance on patient-centred care. This study protocol could be used in more endometriosis care centres in the future and might also be useful for improving patient-centredness in other chronic diseases.

On mediating agents’ moves and how they might affect patient-centredness in mediated medical consultations

The present study aims to shed some light on indicators that might potentially challenge patient-centredness (as practised by self-professed patient-centred doctors) within a mediated medical encounter, and to contribute to the fields of linguistics, translation studies and medical communication. Selected instances of transcribed video recordings are analysed within the framework of Goffman’s footing and participation roles, while transcribed audio recorded interviews with participants in the triad are taken into consideration as well. Both verbal and non-verbal cues (i.e., gaze) are taken into account. The data is drawn from a corpus of video-recorded mediated consultations in a urban hospital in Belgium. Hospital ethical approval and subjects’ written informed consent have been obtained

What do patients expect? Assessing patient-centredness from the patients’ perspective: an interview study

ObjectiveAlthough there has been much conceptual work on patient-centredness (PC), patients‘ perspectives on PC were neglected. In a previous study, participating patients rated the relevance of 16 dimensions of an integrative model of PC as high to very high. However, it remained unclear which specific behaviours described in the dimensions were considered most relevant. Thus, the aim of the current study was to further explore which of the specific behaviours described in the model are especially relevant for the high ratings in the previous study.Methods and designWe conducted semistructured interviews with 20 patients with chronic diseases (16 females, 4 males, mean age: 52 years). Patients answered questions regarding their experiences in the German healthcare system and how optimal healthcare would look like from their perspective. Furthermore, patients were asked to reflect on the most important aspects which they had mentioned in the interview before. Data were analysed via content analysis.ResultsParticipants addressed many different aspects of PC, but mostly focused on three major themes: (1) time appropriate access to care, (2) competence, empathy and being taken seriously by HCPs, (3) HCPs’ individual consideration of each patient’s situation (eg, wishes and needs). Minor themes were: (1) taking a holistic perspective of the patient, (2) patient-centred communication, (3) integration of multidisciplinary treatment elements, (4) transparency regarding waiting time and (5) reduction of unequal access to care.ConclusionThis study enriches the construct of PC by depicting essential aspects of PC from the patients’ perspective. The results allow prioritising strategies to implement patient-centred care. Thus, this study helps to pursue the ultimate goal of fostering patient-centred healthcare delivery in Germany.

Shared decision-making in patient–doctor consultations – How does it relate to other patient-centred aspects and satisfaction?

Background This study was designed to investigate how patient-reported shared decision-making relates to other aspects of patient centredness and satisfaction. Methods Questionnaire study with patients. Consecutive patients in primary care responding post visit. Associations are presented as proportions, positive predictive values, with 95% confidence intervals. Results 223 patient questionnaires were included. 62% (95% Confidence interval (CI): 55–69) of the patients indicated the highest possible rating of being involved in the decisions about their ongoing care (self-reported SDM). Self-reported SDM had a positive predictive value (PPV) of between 85% (CI: 77–90) and 95% (CI: 90–98) for five other patient-centred aspects and satisfaction. Conclusion The results suggest that shared decision making is the patient-centred aspect hardest to achieve and that a patient-centred process leading up to the decision-making increases the chance of the patient being involved in the decision-making.

Implementation challenges to patient safety in Guatemala: a mixed methods evaluation

BackgroundLittle is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala.MethodsWe used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation.ResultsWe found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions.ConclusionImplementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.

Reporting on individual experience

This paper proposes a new model for a patient-centred medical case report. Patient-centred approaches adopt the patient’s perspective and emphasise the individual’s experience of illness, and are intended to answer criticisms that medical texts for professionals, by focusing solely on a disease phenomenon presented within a framework of biomedical reasoning, depersonalise the patient and fail to engage in patient advocacy. The paper provides a systematic review of the most important strands in research on medical case reporting, taking a socio-cultural approach that focuses specifically on the evolution of the genre and on existing examples of patient-centredness that could form a basis for the new model. The aim here is to offer the first systematised proposal containing guidelines already available in the literature, as well as to provide recommendations on how to write about patients in medical case reports in way that does not depersonalise them.