Person-centered care

In health care, person-centred care is where the patients actively participate in their own medical treatment in close cooperation with the health professionals. Sometimes relatives are also included in creating the health plan[1] The person-centred model of health care is used both for in and out patients, emergency care, palliative care as well as in rehabilitation.

Background

The concept of person-centred care is clearly distinguished from a traditional treatment model which views the patient as a passive receiver of a medical intervention [2] Many health professionals are traditionally focused on the needs of the patients instead of their resources. Rather than the conventional way of making medical recommendations from health professionals to a patient, the person-centred care model allows for an inclusion of the patient and their relatives in making a joint design and mutual agreements of the medical plans and treatments. The person-centred care concept involves a partnership between the health care professionals, the patient and the relatives with a starting point in the medical history of the patient. The overall perspective of the life situation of the patient is considered to create objectives and strategies for both short and long term monitoring.[3]

The concept of person-centred care has grown to be internationally associated with successful outcomes of the health care.[4] Initially, the method was developed for senior patients and patients with intellectual disabilities but the ideas have later spread to other medical fields.

Within person-centred care, the patient is considered an independent and capable individual with their own abilities to make informed decisions. Autonomy and participation are always emphasised and respected. For the patient, the person-centred approach allows for involvement and extended possibilities to take responsibility for their own health and treatment.[3][5][6][7][8]

Key principles

There are four vantage points that constitute the foundation of person-centred care:

  • The health care should be based on the unique person's needs and his or her right to health
  • The health institution should focus on the abilities of the person and encourage activity
  • The health care should be coherent
  • Health professionals should always approach patients with dignity, compassion and respect. They should work with an ethical perspective.

Person-centred care is based on a holistic approach to health care that takes the whole person into account instead of a narrow perspective where the focus lies on the illness or the symptoms. The person-centred approach also includes the person's abilities, or resources, wishes, health and well-being as well as social and cultural factors.[9]

There are three central themes to person-centred care work: the patient's narrative, the partnership and the documentation.

The partnership

The health care team may consist of several different professionals with varying expertise from different health care units. The patient is a natural part of the team. Within the team, the patient and relatives have discussions with health professionals aiming to reach a mutual understanding on how to achieve a safe and accurate care for the unique patient.

The documentation

The personal health or care plan is designed to capture the patient's narrative. A common understanding of strategies, goals and evaluation of the outcomes should be established. The documentation should clearly state the responsibilities of each member of the team, including the patient's own role and obligations. To fully live up to the person-centred care concept, patients should have full and easy access to all information and documentation about them. For reasons of security, accessibility and cost effectiveness, all documentation should be digital and include all medical records. The person's own notes, reports of health status and the overall health plan should also be carefully documented. The collected documentation is the foundation of the health care.

Person-centred care research

Research on person-centred care is carried out in many different universities. The University of Gothenburg Centre for Personcentred Care, GPCC, in Sweden, has been established since 2010. The centre conducts interdisciplinary research funded partly by the Swedish government's investments targeted towards care sciences.

Patient-centered care is a concept which also emphasises the involvement of the patient and their families in the decision making of medical treatments. A main difference is that person-centred care describes the whole person in a wider context rather than the patient-centred approach which is based on the person's role as a patient.

People-centred care is an umbrella term, articulated by WHO among others,[10] which entails the right and duty for people to actively participate in decisions at all levels of the health care systems. People-centred care focuses both on the individual's right to health, access to health care and information, but also health literacy on a collective level.

Health activation is a condition where a health care consumer is equipped, educated, and motivated to be an effective manager of their own health and use of health care services.[11][12][13] The concepts are very similar, although person-centred care places the emphasis on the healthcare provider, whereas the term health activation is used in reference to the attitude and behavior of the patient.

References
  1. Shi Tai; Xin-Qun Hu; Dao-Quan Peng; Sheng-Hua Zhou; Xi-Long Zheng (15 May 2016). "The roles of autophagy in vascular smooth muscle cells". International Journal of Cardiology. 211: 1–6. doi:10.1016/j.ijcard.2016.02.128. PMID 26954728.
  2. Tinetti ME, Fried T. The end of the disease era. American Journal of Medicine. 2004;116(3):179-85.
  3. Hörnsten, Åsa (2013). "Översikt personcentrerad vård" [Overview of person-centered care]. Värdhandboken (in Swedish). Umeå University. Archived from the original on 28 June 2015.
  4. McCormack, Brendan; McCance, Tanya (15 June 2010). Person-centred Nursing: Theory and Practice. Wiley. ISBN 9781444390490.
  5. Fors, Andreas (6 May 2015). "Person-centred care after acute coronary syndrome, from hospital to primary care — A randomised controlled trial". International Journal of Cardiology. 187: 693–699. doi:10.1016/j.ijcard.2015.03.336. PMID 25919754.
  6. Edvardsson, David; Ekwall, Anna; Hällgren Graneheim, Ulla; Meidell, Liv; Norberg, Astrid; Santamäki Fischer, Regina; Svanström, Maria; Törnquist, Agneta; Wijk, Helle (2009), Willman, Ania (ed.), Personcentrerad omvårdnad: i teori och praktik [Person-centered nursing: in theory and practice] (in Swedish), Studentlitteratur AB, retrieved 31 May 2016
  7. Ekman, Inger; Swedberg, Karl; Taft, Charles; Lindseth, Anders; Norberg, Astrid; Brink, Eva; Carlsson, Jane; Dahlin-Ivanoff, Synneve; Johansson, Inga-Lill (1 December 2011). "Person-Centered Care – Ready for Prime Time". European Journal of Cardiovascular Nursing. 10 (4): 248–251. doi:10.1016/j.ejcnurse.2011.06.008. ISSN 1873-1953. PMID 21764386.
  8. Hake, Carl-Magnus (4 October 2015). "Personcentrerad vård stärkte hjärtpatienter" [Person-centered care strengthened cardiac patients]. Dagens Medicin (in Swedish). Retrieved 31 May 2016.
  9. Ekman, Inger; Norberg, Astrid; Kristensson Uggla, Bengt; Swedberg, Karl; Lindström Kjellberg, Irma; Hök, Jesper; Wolf, Axel; Carlström, Eric; Lidén, Eva; Svensson, Staffan; Edvardsson, David; Dudas, Kerstin; Kaczynski, Jerzy; Olsson, Lars-Eric; Saldert, Charlotta; Fors, Andreas; Skärsäter, Ingela; Klang, Mathias; Hedman, Håkan; Boström, Anne-Marie; Sandman, Per-Olof; Stenwall, Ewa; Kindblom, Kristina (2014). Personcentrering i hälso-och sjukvård: från filosofi till praktik [Person centering in health-care: from philosophy to practice] (in Swedish). Liber. ISBN 9789147114054. Retrieved 31 May 2016.
  10. "What is people-centred health care?". World Health Organization, Western Pacific Region. Archived from the original on 19 January 2018.
  11. Bricker, Eric (5 May 2016). "What is Health Activation?". Compass Professional Health Services. Archived from the original on 30 December 2016.
  12. "Patient Activation Measure® (PAM®)". Insignia Health. Archived from the original on 4 December 2016. Retrieved 28 December 2016.
  13. {{cite web | first = Ginger | last = Lerner-Wren | title = The Need for Health Activism in the Criminal Justice System | date = 30 May 2015 | work = HuffPost | publisher = Verizon Media | url = http://www.huffingtonpost.com/ginger-lernerwren/the-need-for-health-activ_b_6965274.html

Further reading
  • Håkansson Eklund, Jakob; Holmström, Inger K.; Kumlin, Tomas; Kaminsky, Elenor; Skoglund, Karin; Höglander, Jessica; Sundler, Annelie J.; Condén, Emelie; Meranius, Martina Summer (January 2019). ""Same same or different?" A review of reviews of person-centered and patient-centered care". Patient Education and Counseling. 102 (1): 3–11. doi:10.1016/j.pec.2018.08.029. PMID 30201221.
  • Paradoxes of person-centred care: A discussion paper
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