Abstract
BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient’s world. Patient-centeredness has been commonly defined through physician’s behaviors aimed at delivering patient-centered care. Yet, it is unclear how ‘person-centeredness’ is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.MethodsWe conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant comparison.ResultsWe identified six themes representing core ‘ingredients’ of person-centeredness in the integrated care context: “Holism”, “Naming”, “Heed”, “Compassion”, “Continuity of care”, and “Agency and Empowerment“, all depicting patient expectations and assumptions on doctor and patient roles in integrated care. We bring examples showing that when these needs are met, patient experience of care is at its best. Yet many patients felt ‘unseen’ by their providers and the healthcare system. We describe how these six themes can portray a continuum between having own physical and emotional ‘Space’ to be ‘seen’ and heard vs. feeling ‘translucent’, ‘unseen’, and unheard. These two conflicting experiences raise questions about current typologies of the patient-physician relationship as a ‘dyad’, the meanings patients attributed to ‘care’, and the theoretical correspondence between ‘person-centeredness’ and ‘integrated care’.ConclusionsPerson-centeredness is a crucial issue for patients in integrated care, yet it was variably achieved in the current pilot. Patients in the context of integrated care, as in other contexts, strive to have their own unique physical and emotional ‘space’ to be ‘seen’ and heard. Integrated care models can benefit from incorporating person-centeredness as a core element.
Highlights
Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care
We interviewed a purposive sample of 22 patients, who were contacted through several GP practices in North-west London, and through the pilot’s Patient and User Committee
Aiming to explore patient narratives related to personcenteredness in the integrated care context, we thematized six ‘ingredients’ of person-centeredness
Summary
Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Patient-centeredness has been commonly defined through physician’s behaviors aimed at delivering patient-centered care. It is unclear how ‘person-centeredness’ is realized in integrated care through the patient voice. Understanding the term simplistically and literally, person-centeredness is all about putting patients first, at the center of health and social care, that is respectful and responsive to individual patient preferences, needs and values. There is evidence to show that outcomes in diabetes improve when patients take an active role in their care These outcomes include improved wellbeing, better communication with the doctors and greater treatment satisfaction [12], better blood sugar control and less functional limitations [13]. Trials demonstrated that improved physiological measures (blood pressure or blood sugar), behavioural measures (functional status), and subjective measures (evaluations of overall health status) were consistently related to specific aspects of physician-patient communication [16,17]
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