Query: patient centred care

title: Determining requirements for patient centred care: a participatory concept mapping study
abstract: BackgroundRecognition of a need for patient centred care is not new, however making patient centred care a reality remains a challenge to organisations. We need empirical studies to extend current understandings, create new representations of the complexity of patient centred care, and guide collective action toward patient centred health care. To achieve these ends, the research aim was to empirically determine what organisational actions are required for patient centred care to be achieved.MethodsWe used an established participatory concept mapping methodology. Cross sector stakeholders contributed to the development of statements for patient centred care requirements, sorting statements into groupings according to similarity, and rating each statement according to importance, feasibility, and achievement. The resultant data were analysed to produce a visual concept map representing participants' conceptualisation of patient centred care requirements. Analysis included the development of a similarity matrix, multidimensional scaling, hierarchical cluster analysis, selection of the number of clusters and their labels, identifying overarching domains and quantitative representation of rating data.ResultsThe outcome was the development of a conceptual map for the Requirements of Patient Centred Care Systems (ROPCCS) ROPCCS incorporates 123 statements sorted into 13 clusters. Cluster labels were: shared responsibility for personalised health literacy; patient provider dynamic for care partnership; collaboration; shared power and responsibility; resources for coordination of care; recognition of humanity skills and attributes; knowing and valuing the patient; relationship building; system review evaluation and new models; commitment to supportive structures and processes; elements to facilitate change; professional identity and capability development; and explicit education and learning. The clusters were grouped into three overarching domains, representing a cross sectoral approach: humanity and partnership; career spanning education and training; and health systems, policy and management. Rating of statements allowed the generation of go zone maps for further interrogation of the relative importance, feasibility, and achievement of each patient centred care requirement and cluster.ConclusionThe study has empirically determined requirements for patient centred care through the development of ROPCCS. The unique map emphasises collaborative responsibility of stakeholders to ensure that patient centred care is comprehensively progressed. ROPCCS allows the complex requirements for patient centred care to be understood, implemented, evaluated, measured, and shown to be occurring.

title: Comparing patients' perspectives of "good care" in Dutch outpatient psychiatric services with academic perspectives of patient centred care
abstract: Over the past six decades, the concept of patient centred care (PCC) has been discussed in health research, policy and practice. However, research on PCC from a patients' perspective is sparse and particularly absent in outpatient psychiatric services.  to gain insight into what patients with bipolar disorder and ADHD consider "good care" and what this implies for the conceptualisation of PCC.  A literature review on the different conceptualisations of PCC was complemented with qualitative explorative research on the experiences and needs of adults with ADHD and with bipolar disorder with mental healthcare in the Netherlands using focus group discussions and interviews.  The elements addressed in literature are clustered into four dimensions: "patient" "health professional" "patient professional interaction" and "healthcare organisation" What is considered "good care" by patients coincided with the four dimensions of PCC found in literature and provided refinement of, and preferred emphasis within, the dimensions of PCC.  This study shows the value of including patients' perspectives in the conceptualisation of PCC, adding elements, such as "professionals listen without judgment" "professionals (re)act on the fluctuating course of the disorder and changing needs of patients" and "patients are seen as persons with positive sides and strengths"

title: Patient Centred Care in Canada: Key Components and the Path Forward.
abstract: Canadians' health and its care continue to evolve. Chronic diseases affect more than 50% of our aging population, but the majority of public and professional stakeholders retain a sense of care quality. An emergent issue, however, is generating an increasingly wide debate. It is the concept of patient centred care, including its definition of key components, and efficacy. To advance the evidence base, the 2013 2014 and 2016 Health Care in Canada (HCIC) surveys measured pan stakeholder levels of support and implementation priorities for frequently proposed components of patient centricity in healthcare. The public's highest rated component was timely access to care, followed by perceived respect and caring in its delivery, with decisions made in partnership among patients and professional providers, and within a basic belief that care should be based on patients' needs versus their ability to pay. Health professionals' levels of support for key components largely overlapped the public's levels of support for key components, with an additional accent on care influenced by an evidence base and expert opinion. In terms of priority to actually implement enhanced patient centred care options, timely access was universally dominant among all stakeholders. Caring, respectful care, also retained high implementation priority among both the public and professionals, as did care decisions made in partnership, and, among professionals, care driven by research and expert opinion. Low priorities, for both the public and professionals, were the actual measurements of patient centred care delivery and its impact on outcomes. In summary, there is remarkable concordance among all stakeholders in terms of favoured interventions to enhance patient centred care, namely, timely access, caring, partnering and communicative delivery of evidence based care. Unfortunately, the lack of contemporary imperative around the value of measuring and reporting actual use and outcomes of favoured interventions means uncertainty of their efficacy will persist for the foreseeable future. Things can be better.

title: Patient perceptions of patient centred care, empathy and empowerment in complementary medicine clinical practice: A cross sectional study
abstract: Patient centred care (PCC) is increasingly recognised as a valuable paradigm of clinical care, particularly in the field of chronic disease. As the use of complementary medicine (CM) grows, so does the need to explore the clinical experience of CM patients. This study aims to provide an examination of patient perceptions of the degree to which CM practitioners employ a patient centred approach during consultation. Design Cross sectional survey preliminary study.  A patient reported survey was administered to assess perceptions of practitioner empathy and support, patient empowerment, and PCC in a multi profession CM student clinic offering acupuncture, homeopathy, naturopathy, nutrition and myotherapy. The survey was comprised of four existing measures: the Consultation and Relational Empathy (CARE) measure, Patient Centred Care scale, Perceived Provider Support scale and Empowerment scale.  Amongst 252 respondents, positive perceptions towards all five professions were consistently reported by participants for all four measures. A higher proportion of positive experiences of practitioner empathy and PCC were reported by participants consulting with a naturopath, nutritionist or homeopath compared to those consulting with a myotherapist or acupuncturist. Participants who visited the clinic for assistance with a chronic health condition reported more positive perceptions for items regarding communication from the Patient Centred Care scale p 0.02 and self efficacy from the CARE measure p 0.04  CM clinical care appears to be characterised by a patient centred, empathic and empowering approach. CM may present a valuable resource of PCC, particularly within the field of chronic disease management. Further research is required in order to explore this approach in the wider CM community.

title: Benefits of Population Segmentation Analysis for Developing Health Policy to Promote Patient Centred Care.
abstract: 1Programme in Health Services and Systems Research, Duke NUS Medical School, Singapore Address for Correspondence: Mr Chong Jia Loon, Programme in Health Services and Systems Research, Duke NUS Medical School, 8 College Road, Singapore 169857.  The philosophy of patient centred care requires a paradigm shift away from fragmented institution centred care to integrated care models such as care teams that develop and implement a care plan tailored to meet patient  While no 2 patients are exactly alike, it is not feasible to focus at the granular level when developing health policies that promote patient centred care. Segmenting the population into relatively homogeneous, distinct subgroups promotes the development of care models tailored to similar groups of people rather than individuals.2,3 Population segmentation, with the aim of optimising healthcare services, originally evolved from market segmentation. Widely applied in the field of business, market segmentation involves tailoring product features for different consumer  Population segmentation analysis can happen at various levels at the macro (e.g. nationwide population) meso (e.g. diabetic patients) and micro levels (e.g. individual adverse event risk stratification)3 with the segments themselves being derived either through expert inputs or post hoc using statistical methods applied to empirical data.4 In order to prepare for an ageing population in Singapore,1 initiatives to integrate care through population segmentation have already been started, such as those by the Agency for Integrated Care.5 As resources are finite, targeted and high value interventions that are enabled by population segmentation analysis have become increasingly relevant. In this article, we discuss the specific benefits of population segmentation analysis for the provision of efficient patientcentred care. These include the facilitation of healthcare service planning, promoting the evaluation of health service innovations and improving care integration.

title: Patient centred care: a call to action for wound management.
abstract: J O U R N A L O F W O U N D C A R E V O L 2 6 N O 1 1 N O V E M B E R 2 0 1 7 6 6 2 Foreword by Marco Romenelli, MD PhD, WUWHS President, Professor of Dermatology, Department of Clinical and Experimental Medicine. University of Pisa, Italy. JWC WUWHS editorial advisory board editor in chief: The World Union of Wound Healing Societies (WUWHS) is proud to partner with the Lindsay Leg Club Foundation and endorse this document on patient centred care. The topics covered in the document have been produced by experts in this field who have participated in the Lindsay Leg Club symposium on patient advocacy held in Florence during the WUWHS conference in September 2016. The content covers several aspects that we face every day during our clinical practice. Patients asking for our expertise not only in managing chronic wounds, but also to have optimal interaction and collaboration with the wound care team treating their condition. The key point is always to put the patient at the centre of wound management. This goal is described here, from different points of view with a focus on the holistic approach to care that considers the patient's needs as a whole rather than treating wound problems in isolation. My role as a WUWHS President will be to make sure that the document receives worldwide distribution in different settings, from scientific societies to political organisations, with the aim of raising awareness on patient advocacy, and to obtain enough credit and understanding to be able to negotiate better quality health care services, together with the highest standards. With my wound care team, at the University of Pisa, have been working, in the last few years, under the umbrella of the European Commission on a research project regarding telemonitoring of patients by means of biomedical sensors. We think that this is a fascinating area of wound care practice in relation to patient centred care, where there is space to improve service to patients in isolated geographical areas not able to reach specialist hospitals. I am sure we will be able, in the not too distant future, to cover the care needs of these patients. I wish this group great success in the years to come and consider this a brilliant initial initiative for us to demonstrate the desire to act on patient advocacy supported by a strong communication strategy across wound care worldwide. Introduction by Ellie Lindsay OBE, Life President of the Lindsay Leg Club Foundation and Chair of the WUWHS International Panel on Patient Advocacy Quite recently, in a surgical ward in the UK, my husband, who was very unwell at the time, said to me, 'will you please be my patient advocate? I was shocked to be asked this and wanted to know why. 'Nobody is listening to me, he said 'I have lain on a bedframe for three nights as the mattress was not working, while the nurses kept saying that the bed mattress was working, but they are wrong. Soon afterwards my husband ended up with a category II pressure ulcer (PU) on top of the serious illness that he was being treated for. One of the core objects of the charity I represent, the Lindsay Leg Club Foundation, is public education on leg health. Wound management is a major demand on health care resources which will continue to escalate with the increasing age and comorbidity profile of the patients that we care for. Prevention needs to be our priority, along with care of existing wounds, but patients also have rights and expectations that need to be taken into account. For example, they should not have to accept developing category II PU as a result of not being listened to, making them reluctant to return to hospital to continue their vital treatment. Many of us have already been advocates for people we are close to. In doing this we may have had to challenge the system that is meant to help and care for us. We are also highly likely to be bedridden ourselves at some point, and we will want those who are close to us to advocate for us too. How confident are we that the structures and policies for patient advocacy and empowerment will exist when this time comes? The aim of this document is to explore the concept and status of patient advocacy with regard to wound care. But it is also more than that. The Task Force panel that put this document together was instigated at the request of the WUWHS, whose objective is to promote a patient centred approach to wound care at an international level. The panel consists of experts, both within and outside wound care, who have devoted a considerable part of their careers to trying to understand, chart and promote the patient experience. We hope that this document will begin a structured process of patient empowerment within wound care that will change policy at the highest level. Patient centred care: a call to action for wound management

title: The importance of patient centred care to overcome barriers in the management of actinic keratosis
abstract: Visible actinic keratosis (AK) lesions and subclinical (non visible) sun damage in the field of cancerization are associated with risk of both non melanoma skin cancer, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and, more rarely, melanoma. As the incidences of AK and skin cancer are increasing, effective prevention and treatment of AK is essential to minimize disease burden and improve patient quality of life. Currently, AK lesions are often left untreated and field therapies are underused. Patient centred care, with a focus on the patient physician relationship, has proven cost effective, and improved clinical outcomes and patient satisfaction in a number of therapy areas. Strategies for applying patient centred care to AK are warranted. Existing barriers to the effective treatment of AK were identified and patient centric strategies to overcome each barrier were discussed. Barriers to effective AK treatment include poor disease awareness (for both patient and physician) concerns associated with the cosmetic effects of treatment, treatment related side effects, cost perceptions for lesion directed vs field directed therapies, and inadequate adherence, particularly with long treatment duration. Overcoming these barriers will involve patient and physician education that promotes: disease prevention and awareness; the importance of self examination; an understanding of treatment options; and the importance of adherence to treatment. To maximize its effectiveness, education should be delivered within a patient centric framework, where the relationship between patient and physician is built on effective communication, empathy and a feeling of partnership. Patient centric care, including patient education, is key to overcoming the barriers associated with effective AK treatment.

title: A cross sectional study investigating patient centred care, co creation of care, well being and job satisfaction among nurses
abstract: Developments in the community health nursing sector have resulted in many changes in the activities of these nurses. The concepts of patient centred care and co creation of care are gaining importance in the work of community health nurses. Whether patient centred care also contributes positively to nurses' well being and job satisfaction is not known.  In 2015, a cross sectional survey was conducted among 153 community health nurses employed by 11 health care organisations in the southern part of the Netherlands. Correlation and regression analyses were performed to identify relationships among patient centred care, co creation of care, background characteristics, job satisfaction and well being of community health nurses.  Patient centred care and co creation of care were correlated positively with community health nurses' well being and job satisfaction. Both variables were predictors of well being, and patient centred care was a predictor of job satisfaction. The length of time in the present position was related negatively to community health nurses' job satisfaction and well being.  Investment in patient centred care and co creation of care is important for the well being and job satisfaction of community health nurses.  To safeguard or improve job satisfaction and well being of community health nurses, organisations should pay attention to the co creation of care and patient centred care.

title: The Graduating European Dentist Domain III: Patient Centred Care.
abstract: This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to patient centred care. This approach is becoming increasingly prominent within the literature and within policy documents. Whilst working to an evidence base is critical, dentists must also be aware of the scientific basis that underpins the treatment they provide. The evaluation process, which supports treatment planning, also requires dentists to be able to listen, collate, and record pertinent information effectively. In addition, the ability to account for a patient's social, cultural and linguistic needs (cultural competence) will result in a practitioner who is able to treatment plan for patient centred care.

title: Interprofessional collaborative patient centred care: a critical exploration of two related discourses
abstract: There has been sustained international interest from health care policy makers, practitioners, and researchers in developing interprofessional approaches to delivering patient centred care. In this paper, we offer a critical exploration of a selection of professional discourses related to these practice paradigms, including interprofessional collaboration, patient centred care, and the combination of the two. We argue that for some groups of patients, inequalities between different health and social care professions and between professionals and patients challenge the successful realization of the positive aims associated with these discourses. Specifically, we argue that interprofessional and professional patient hierarchies raise a number of key questions about the nature of professions, their relationships with one another as well as their relationship with patients. We explore how the focus on interprofessional collaboration and patient centred care have the potential to reinforce a patient compliance model by shifting responsibility to patients to do the "right thing" and by extending the reach of medical power across other groups of professionals. Our goal is to stimulate debate that leads to enhanced practice opportunities for health professionals and improved care for patients.