Patient-centered, Person-centered, and Person-directed Care

Abstract

The traditional “medical model” of health care consists of evaluating symptoms and complaints, prescribing treatments, and assessing outcomes—typically with a doctor or some other highly trained professional making the decisions. The role of the professional is to decide; the role of the patient is to comply with the decisions of the professional. As the health care and long-term services and supports systems move away from this paternalistic, doctor-knows-best approach, consumers are playing more active roles in their care. The Institute of Medicine has declared that patient-centered care—care that is “respectful of and responsive to the preferences, needs, and values” of the individual, “ensuring that the care recipient’s values guide all clinical decisions”—is a hallmark of high-quality care. 1 Patient-centered care promotes access to personal health information by computers or mobile phones, making patients better informed and more active participants in their care. Patient-centered care also gives priority to outcomes that are important to the patient—such as quality of life—over technical and process measures. 2 The IOM’s definition of patient-centered care could be expanded with terminology that denotes greater holism and empowerment. In place of the medical model, and expanding the patient-centered concept, are the models of person-centered and person-directed care, terms that are poorly understood and inconsistently applied. These other approaches to care vary according to who is the decision maker and the role of coordination and nonmedical services and concerns. Table 1 summarizes the similarities and differences across these terms. A health care system providing person-centered care would focus on the whole person (not just his or her medical conditions), and—perhaps even more radically—a health system providing person-directed care puts individuals in control of decisions about their care. 3,4 Person-centered and person-directed care approaches represent a paradigmatic shift in focus away from the biomedical approach; they emphasize social, mental, emotional, and spiritual needs, as well as individuals’ strengths, weaknesses, preferences, and values. Future research is needed in order to test the validity of our assignments of low/moderate/high/very high in Table 1, and—more importantly—the relative effectiveness of the different models. Research is also needed to better understand the preferences that care recipients have about different approaches to their care. Some individuals and families may, in fact, prefer the medical model because they are reassured by a paternalistic approach and do not wish to be decision makers. Not everyone wants to be in the director’s chair, and these preferences are also valid, but not unless some element of choice is involved. The holistic and empowering approach exemplified by person-centered and persondirected care is not a traditional part of the training for physicians and other health care providers, although there have been movements in that direction. 5 Nonetheless, recognizing each individual as a whole person with distinct goals, needs, and preferences is