Abstract
Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care-based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research.
Highlights
Person centredness is currently promoted across international health systems as part of a turn towards more participatory health care (Castro, Van Regenmortel, Vanhaecht, Sermeus, & Van Hecke, 2016)
Definitions of person-centred care (PCC) and participation have evolved and converged in recent years (Castro et al, 2016; Fumagalli, Radaelli, Lettieri, Bertele’, & Masella, 2015). This has been facilitated by sustained investment, for example by the Swedish government (Ekman, Hedman, Swedberg, & Wallengren, 2015) and through the work of others (McCormack and McCance 2006, McCormack and McCance 2010)
The evaluations assessed patient outcomes in health and wellbeing, implementation barriers and facilitators and addressed the research question of whether the interventions, which aimed to promote person-centred care (PCC) for individuals with multimorbidity living in the community, were aligned with the Gothenburg Centre for Person Centred Care (GPCC) routines (Close et al, 2019; Lloyd, Close, Wheat, Horrell, & Kirkpatrick, 2016; Sugavanam et al, 2018)
Summary
Person centredness is currently promoted across international health systems as part of a turn towards more participatory health care (Castro, Van Regenmortel, Vanhaecht, Sermeus, & Van Hecke, 2016). This approach proposes a model of personhood beyond the biomedical features embodied in the role of ‘patient’. In the UK the concept of person centredness has been introduced within the context of fiscal constraint in statutory services This has led some patients to believe changes in their care represent the neoliberal shrinking of public services in light of the costs incurred by growing numbers of people with long term conditions and multi-morbidity. Lloyd et al (Horrell, Lloyd, Sugavanam, Close, & Byng, 2017; Lloyd et al, 2017) have added a fourth routine: (4) an agreement to act in conjunction with the patient and other professionals to coordinate care
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