Collaborative Care Planning Research Articles

Integrating psychiatry and family medicine in the management of somatic symptom disorders: Diagnosis, collaboration, and communication strategies

AbstractSomatic symptom disorders (SSDs) present a complex interplay of physical and psychological factors, necessitating an integrative approach to diagnosis and management. This article explores the collaborative efforts between family medicine and psychiatry in addressing SSDs, emphasizing the importance of a multidisciplinary strategy for comprehensive patient care. Effective diagnosis involves recognizing the significance of both somatic symptoms and the patient's psychological response, with tools like structured clinical interviews and self‐report questionnaires playing crucial roles. Management strategies include psychotherapeutic interventions such as cognitive behavioral therapy (CBT), pharmacological treatments, and lifestyle modifications, all tailored to the patient's needs. Communication strategies are vital in validating patients' experiences while addressing underlying psychiatric issues. Techniques such as active listening, biopsychosocial framing, and the teach‐back method foster trust and improve treatment adherence. Cultural considerations and the use of interpreters enhance communication with diverse patient populations. Training programs for healthcare providers further improve competency in managing SSDs. This integrative approach aims to enhance patient outcomes by addressing the multifaceted nature of SSDs through collaborative care, effective communication, and comprehensive treatment planning.

Utilizing a Geriatric Emergency Multi-disciplinary Service (GEMS) To Improve Care For Nursing Home (NH) Residents In The Emergency Department (ED)

Abstract Background The GEMS team provides an age attuned service for older adults living with frailty who present to the ED. Under the governance of a Geriatrician older adults living with frailty receive a Comprehensive Geriatric Assessment (CGA) and a collaborative plan of care. NH residents are often the most frail cohort of patients. They can sometimes be referred to the ED with needs that could be managed in the community. Moreover, transfer is associated with a higher risk of mortality (Lemoyne et al. 2019). To address this, all NH residents are classified as priority one by the GEMS Team. Pathways have been developed to the Community Integrated Hub for the Older Person (ICPOP), General Practitioners and Community Palliative Care Teams. The goals is to provide the right care, in the right place and at the right time. Methods Plan, Do, Study, Act (PDSA) Quality Improvement Methodology was utilized. Data was collected on all NH patients presenting to ED and interrogated over a 3-month period. Results 27 patients presented to ED from a nursing home during the collection period. (n=16) 60% of patients were discharged. 89% were living with severe frailty. 100% received a CGA, Advanced Care Planning and family liaison. (n=5) referred to ICPOP. (n=6) referred to Palliative Care through the GP. Conclusion The majority of patients reviewed were living with severe frailty and likely beginning the final journey of their lives. A CGA on presentation to ED ensures the goals of care are aligned with the persons will and preference. Alternative care pathways in the community enabled patients to be discharged back to the nursing home with appropriate follow-up supports. Reference 1. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics. 2019 Dec; 19:1-9.

Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care

ObjectiveThis study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.DesignSecondary data analysis of institution-based cross-sectional national survey data.SettingData...

Conceptualizing person undergoing rehabilitation care in the light of Axel Honneth’s theory of recognition

Objective: To reflect on the concept of person, in the context of rehabilitation, in the light of Axel Honneth’s Theory of Recognition. Methods: Theoretical-philosophical essay. Results: The concepts of person, patient, user or client have given rise to central debates in health care models, especially in the area of rehabilitation. In this context, the concept of person stands out, from an anthropological and theological perspective to the inclusion of the complexity of social interactions in this meaning. Axel Honneth adds to this view by reflecting on the individuation of the being through the foundation of recognition, sustained by the need for self-confidence, self-respect and self-esteem, making it possible to draw up a collaborative care plan that strives for the good life of the person undergoing rehabilitation. Conclusion: We can conclude that conceiving of care centered on people with disabilities is much more coherent nowadays than perpetuating other debatable expressions in terms of health. Regardless of the term to be used, recognizing all the dimensions inherent in the concept of person is fundamental in terms of establishing the integral dialogical relationship that is intended between health professionals and the person-patient-user-client undergoing rehabilitation.

Caregiver and Care Team Perceptions of Online Collaborative Care Planning for CMC.

Care plans summarize a child with medical complexity's (CMC) medical history and ongoing care needs. Often, the health care team controls the care plan content, limiting caregivers' ability to edit the document in real time and potentially compromising accuracy and utility. With this study, we aimed to provide caregivers of CMC with online access and shared editing control of their child's care plan and to explore the experiences of caregivers and care team members (CTMs) after using an online collaborative care plan (OCCP). Caregivers of CMC were recruited from a tertiary complex care program to use an online, patient-facing platform for 6 months, which included the ability to edit and share their child's care plan. Caregivers and CTMs participated in semi-structured interviews to explore their experiences in using the OCCP. Consistent with grounded theory methodology, a constant comparative analysis was used, which allowed for theoretical sampling and theory generation. A total of 15 caregivers and 20 CTMs completed interviews. Interviews revealed 3 major themes and 9 subthemes, including (1) the navigation of uncharted roles (trust, responsibility), (2) the requirements for success (electronic medical record integration, online access, collaborative care plan review), and (3) cohesive care (accessibility and convenience, being on the same page, autonomy). Themes informed the creation of a theoretical model for the implementation and utility of OCCPs. Online, collaborative care plans, when implemented safely and thoughtfully, promote shared understanding, improve caregiver autonomy, and increase the accessibility of health information. Together, these benefits facilitate cohesive care and authentic partnership between caregivers and CTMs in the care of CMC.

Availability and readiness of health facilities providing services for other infectious diseases to treat neglected tropical diseases in Ethiopia: implications for service integration in high burden areas

BackgroundThe burden of neglected tropical diseases (NTDs), HIV/AIDS, tuberculosis, and malaria pose significant public health challenges in Ethiopia. This study aimed to the explore service availability and readiness for NTD care among Ethiopian health facilities treating tuberculosis (TB), HIV/AIDS, and/or malaria.MethodsThis study utilized secondary data from the Ethiopian Service Provision Assessment 2021–22 survey. The availability of services was calculated as the percentage of HIV/AIDS, tuberculosis, or malaria facilities providing NTD services. Facilities were considered highly prepared to manage any type of NTD if they scored at least half (> 50%) of the tracer items listed in each of the three domains (staff training and guidelines, equipment, and essential medicines). Descriptive statistics and logistic regression models were employed to present the study findings and analyze factors influencing facility readiness, respectively.ResultsOut of 403 health facilities providing NTD care nationally, 179, 183, and 197 also offer TB, HIV/AIDS, and malaria services, respectively. The majority of TB (90.1%), HIV/AIDS (89.6%), and malaria (90.9%) facilities offer soil-transmitted helminth services, followed by trachoma (range 87–90%). The percentages of the aforementioned facilities with at least one trained staff member for any type of NTD were 87.2%, 88.4%, and 82.1%, respectively. The percentage of facilities with guidelines for any type of NTD was relatively low (range 3.7–4.1%). Mebendazole was the most widely available essential medicine, ranging from 69 to 70%. The overall readiness analysis indicated that none of the included facilities (TB = 11.9%; HIV/AIDS = 11.6%; and malaria = 10.6%) were ready to offer NTD care. Specifically, a higher level of readiness was observed only in the domain of medicines across these facilities. Hospitals had better readiness to offer NTD care than did health centers and clinics. Furthermore, a significant associations were observed between facility readiness and factors such as facility type, region, presence of routine management meetings, types of NTD services provided, and fixed costs for services.ConclusionsEthiopian health facilities treating TB, HIV/AIDS, and malaria had an unsatisfactory overall service availability and a lack of readiness to provide NTD care. Given the existing epidemiological risks and high burden of TB, HIV/AIDS, malaria, and NTDs in Ethiopia, there is an urgent need to consider preparing and implementing a collaborative infectious disease care plan to integrate NTD services in these facilities.

Building Interprofessional Competency Through A Virtual Cardiopulmonary Case Collaboration

Introduction Interprofessional education (IPE) experiences are prioritized as a key component of physician assistant (PA) and Doctor of Physical Therapy (DPT) education programs’ curricula to reflect contemporary practice. Virtual IPE is reported to facilitate clinical decision making and teamwork in students. However, limited studies exist on its effectiveness to promote the IPE Collaborative's (IPEC) core competencies. As we aim to increase IPE in our curriculum, virtual IPE offers several advantages. The purpose of this study was to evaluate whether a case-based, virtual IPE improved students' knowledge and attitudes of collaborative team skills using the Interprofessional Collaborative Competencies Attainment Scale (ICCAS). Methods This study used a retrospective pretest-posttest design. Students in first-year PA and DPT programs (n = 130, PA = 48, DPT = 82) completed the ICCAS survey before and after attendance of a mandatory virtual IPE event. The virtual IPE session centered on designing a collaborative plan of care for an individual with congestive heart failure in an outpatient setting. To assess skill attainment, students completed the ICCAS survey. t Tests with Bonferroni's correction (P < .01) were conducted for analyses. Results One hundred twenty-two students (PA = 46, DPT = 76) provided complete survey data. Statistically significant improvement was noted for all 20 questions (P < .001). Large pre/post-IPE event effect sizes were observed for all 20 statements in the ICCAS. No statistically significant differences between the 2 disciplines were noted. Discussion Our findings suggest that a virtual case-based IPE experience may offer benefits to improve the student's attitude and knowledge related to IPEC during the initial year of PA and DPT programs. These data are encouraging as integration of virtual IPE experiences may affect teamwork competencies in healthcare programs.

Designing technology to support greater participation of people living with dementia in daily and meaningful activities.

People living with dementia should be at the center of decision-making regarding their plans and goals for daily living and meaningful activities that help promote health and mental well-being. The human-computer interaction community has recently begun to recognize the need to design technologies where the person living with dementia is an active rather than a passive user of technology in the management of their care. Data collection comprised semi-structured interviews and focus groups held with dyads of people with early-stage dementia (n = 5) and their informal carers (n = 4), as well as health professionals (n = 5). This article discusses findings from the thematic analysis of this qualitative data. Analysis resulted in the construction of three main themes: (1) maintaining a sense of purpose and identity, (2) learning helplessness and (3) shared decision-making and collaboration. Within each of the three main themes, related sub-themes were also constructed. There is a need to design technologies for persons living with dementia/carer dyads that can support collaborative care planning and engagement in meaningful activities while also balancing persons living with dementia empowerment and active engagement in self-management with carer support.

Advancing Collaboration across the Multiple Myeloma Treatment Journey from Oncology Clinic to CAR T-Cell Center: A Paired Center Transformative Quality Improvement Initiative

Background Treating patients with multiple myeloma (MM) is a complex endeavor that requires effective clinical decision-making from a team of specialists and supporting clinicians. Additionally, treatment with chimeric antigen receptor (CAR) T-cell therapy presents unique challenges, requiring communication and collaboration between the oncology clinic and CAR T-cell treatment centers. To improve collaborative MM care, we conducted a quality improvement (QI) study, bringing together community and academic oncology centers to assess current practice patterns and develop strategies to overcome barriers in the treatment of patients with MM across the continuum of care. Methods This QI initiative is comprised of baseline provider surveys (Community n = 21; Academic n = 18) and pre- and post-surveys of providers (n = 31) participating in small-group, team-based audit-feedback (AF) sessions (Table 1). Survey questions were designed to assess knowledge, confidence, and experiences in keeping up with the latest clinical evidence and guideline recommendations and collaboration and communication practices between centers. Care teams from each clinic, along with a nationally renowned expert MM physician, participated in audit and feedback sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Results Provider Surveys: When asked their top challenge encountered in managing patients with MM, community-based providers reported keeping up with clinical evidence for new and emerging therapies (48%), whereas academic-based providers reported knowing how to optimally sequence therapies (50%). Further differences between community and academic clinicians were evident in their self-reported confidence in their ability to stay up-to-date with new data on CAR T-cell therapies and other MM treatment (high/very high confidence: 84% academic; 24% community; p < .001), ability to align clinical practices with evidence-based guidelines (high/very high confidence: 72% academic; 34% community; p = .018), and ability to sequence lines of therapy and differentiate between novel therapies for MM (high/very high confidence: 72% academic; 29% community; p = .007). Despite these differences, care teams from both settings reported low percentages of eligible patients have received CAR T-cell therapy for MM, citing patient resistance, cost and difficulty gaining insurance approval as top barriers (Figure 1). When asked to rate the level of communication and collaboration between academic and community centers, 44% of academic providers and 35% of community providers rated very good/excellent. The top barrier among providers not indicating very good/excellent communication from both settings was lack of time for our clinic's staff to communicate. AF Sessions: Providers participating in the small group AF sessions reported gaining access to newer therapies (55%) as their biggest challenge regarding MM management. Clinicians indicated gains in moderate/high/very high confidence in their ability to align treatment decisions with guidelines and clinical evidence for MM (78% to 92%) and ability to sequence treatment options across multiple lines of therapy for patients with MM (80% to 100%). Care teams set goals to enhance knowledge of clinical efficacy and safety of new and emerging therapies for MM. Action plans to achieve these goals include developing a hematology disease specific tumor board to collaborate on patient care plans, further train designated staff members focused on CAR T-cell/MM, discuss relevant new data to improve the team's confidence in therapy sequencing and early referrals to CAR T-cell centers. Conclusions Through this QI initiative, clinical teams identified barriers to optimal MM care, creating and implementing specific action plans to increase knowledge of current and emerging therapies for MM to enhance individualized treatment plans. While meaningful confidence gains were demonstrated, these data underscore clinical practice gaps to address in future initiatives to support evidence-based, collaborative care plans for patients with MM. Study Sponsor Statement The study reported in this abstract was funded by educational grants from Bristol Myers Squibb. The grantors had no role in the study design, execution, analysis, or reporting.

Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy

IntroductionPersonal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS).MethodsService users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests.ResultsTen women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS).ConclusionsOur findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation.

An Opportunity to Study Mechanisms of Palliative Care by Integrating into Management of The Treatment of Renal Cancer Carcinoma

Achieving patient-centered care requires helping patients understand their illness, eliciting patient values, and developing a collaborative care plan with input from patient and physician. Combining existing models in communication skills and shared decision making provides a road map for accomplishing these tasks in delivering patient-centered care. In this article, we highlight the importance of patient understanding of their prognosis as a key step in delivering patient-centered care. We then review literature suggesting that both patient and patient’s physicians’ emotions play an inhibitory role in accurate formulation and communication of prognosis by physicians and accurate incorporation of this information by patients. We postulate that the finding of benefit of early integration of palliative care (PC) in improving patient-centered outcomes may be addressing these inhibitory factors. Key skills of empathic communication by a PC team that is focused on addressing patient emotions may facilitate better understanding of prognosis and thus improved patient-centered decision leading to improved patient centered outcomes. Finally, we propose advances treatment of renal cell carcinoma makes it an ideal disease that can inform this hypothesis of how integration of PC works. Specifically, we propose that the curability potential in metastatic RCC, amplifies challenges associated with patient prognostic understanding and decision making. Studying which discipline – primary oncology team or palliative care team – can help patients achieve more accurate prognostic understanding leading to more patient centered choices and improved patient-centered care.

Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives.

With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions. This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period. Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment. This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress. No patient or public contribution.

The tertiary service for psychosis: Holistic recommendations for people with complex psychosis.

To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73-100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.

A Randomised Control Trial to Explore the Impact and Efficacy of the Healum Collaborative Care Planning Software and App on Condition Management in the Type2 Diabetes Mellitus Population in NHS Primary Care.

Effective and scalable solutions to support management of Type2 Diabetes (T2D) at a distance are a priority for health systems worldwide. The use of personalised care planning has been shown to be effective at improving the health outcomes and the experience of care amongst people with T2D and other long-term health conditions. Here we describe a specific example of such an intervention. The sample comprised 197 participants with T2D randomised to either the active intervention group with digital health planning (App + usual care), with 115 participants, or the control group (usual care), with 82 participants. We analysed data in relation to changes in body mass index (BMI)andglycated haemoglobin (HbA1c) over a 6-month follow-up period. We also analysed responses to questionnaires sent out and held interviews with participants that were in the active treatment group and therefore had a care plan created and access to an app. The active treatment group had significant reductions in HbA1c (p < 0.01) and BMI (p < 0.037) vs the control group (no significant change). The average percentage change in HbA1c for the treatment group over 6months was - 7.4% (± SE 1.4%), compared with 1.8% (± SE 2.1%) for the control group. The average percentage change in BMI for the treatment group was - 0.7% (± SE 0.4%) and it was - 0.2% (± SE 0.5%) for the control group. A higher percentage of the active treatment group reduced their HbA1c and BMI than the control group. For HbA1c, 72.4% of the active treatment group reduced their HbA1c, compared to 41.5% of the control group. For BMI, 52.7% of the active treatment group experienced a reduction, compared to 42.9% for the control group. Self-measured quality of life (QoL) improved for patients in the active treatment group, shown by an increase in theirpre-trial to post-trial EQ-5D-5L rating by an average of 0.0464 (± SE 0.0625), compared to a decrease of 0.0086 (± SE 0.0530) for the control group. The average EQVAS score also increased pre- to post-trial for the active treatment group, on average by 8.2%, whereas it decreased by an average of - 2.8% for the control group. These findings point to how the provision of personalised plans of care, support and education linked to a mobile app, can result in HbA1c and BMI reduction for many individuals with T2D. The use of a patient management app as well as a personalised care plan also led to an improvement in patient self-rated QoL and engagement.

In-person and virtual delivery of a multigenerational, unfolding case study to support student learning and skill development in interprofessional collaboration

A multigenerational case study in an outpatient clinic setting was utilized to allow advanced practice nursing and graduate level social work students to practice interprofessional collaboration. The primary objective of this event was for the learners to better understand each other's roles and practice communication techniques to facilitate the development of a collaborative plan of care. The learning activity included pre-event didactic education, collaborative plan of care development with unfolding case details, and facilitator-led debriefing. A pre/post reflection and survey were used to assess the impact and value of the experience and understanding of the partnering profession. In the third year, the delivery format was switched to virtual. Analysis showed that students valued the learning opportunity whether delivered in person or virtually. Overall, the event was shown to be effective both in-person and virtually implemented in promoting integrated care.

Impact of an Emergency Department Simulation on Pharmacy Students' Interprofessional Team Skills and Attitudes.

Objective: To evaluate the impact of an emergency department simulation on pharmacy students' interprofessional team skills and attitudes as measured by a novel mixed methods approach. Methods: A simulated emergency department encounter was executed by interprofessional teams consisting of pharmacy and medical students. Two rounds of the same encounter were separated by a short debriefing session facilitated by pharmacy and medical faculty. A full, comprehensive debriefing session occurred after conclusion of the second round. Pharmacy faculty evaluated pharmacy students using a competency-based checklist after each round of the simulation. Pharmacy students completed a baseline self-assessment of their interprofessional skills and attitudes pre-simulation, and again post-simulation. Results: Pharmacy students demonstrated significant improvement in providing clear and concise verbal interprofessional communication and using shared decision making to develop a collaborative plan of care, based upon student self-assessment and faculty observational ratings. Student self-assessments also showed significant perceived growth in contributing to the team's plan of care, and demonstrating active listening skills within the interprofessional team. Through qualitative analysis, pharmacy students noted perceived self-improvement in a variety of team-based skills and attitudes including confidence, critical thinking, role identification, communication, and self-awareness. Conclusion: This simulation provided a learning opportunity for pharmacy students to improve their skills related to teamwork and interprofessional collaboration. Based upon a novel a mixed methods assessment, both student self-assessment and faculty observational ratings were associated with significant growth in interprofessional skills and attitudes. This simulation provides a template experience for colleges/schools to meet, at least in part, ACPE Standards related to interprofessional education in collaboration with medical students.

Collaborative care planning as a person-centred practice -Interpreted synthesis of four empirical studies and their results

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Collaborative care planning as a person-centred practice-Interpreted synthesis of four empirical studies and their results

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Considering patient narrative-based and medico-scientific epistemologies in framing psychiatric care.

Personal narratives of lived experience with psychiatric illness and distress remain central in the epistemology of mental illness. We provide a commentary on this potential bridging of patient narrative-based epistemology, and medico-scientific epistemology used by psychiatrists used for diagnosis, formulation, prognosis and treatment. Discussion and planning of psychiatric care can be framed by understanding the narrative-based epistemology of a patient's illness as highlighted by five key questions to explore the patient's illness explanatory models. We propose five key questions for the psychiatrist's complementary consideration of medico-scientific epistemology that frame conceptual models of aetiology, pathophysiology, diagnosis, formulation, prognosis and treatment, which are embedded in the predominant socio-cultural environment. These questions assist in bridging patient narrative and medico-scientific explanatory models to facilitate more effective collaborative care planning.

Reflections of the collaborative care planning as a person-centred practice.

The ageing population is increasing worldwide with an increase in chronic disorders. At the same time, person‐centred care has become a policy within both health and social care. To facilitate coordination and collaboration and integrate the older adult's perspective in the decision‐making process the collaborative care planning process with the development of a written care plan can be used. In this study, the result of an interpreted analysis of four empirical studies of the collaborative care planning as a person‐centred practice will be discussed and reflected on. A framework based on the French philosopher Paul Ricoeur's little ethics was used in the synthesis of the studies. The findings revealed two common threads: personhood and power asymmetry. Both challenges in achieving a person‐centred collaborative care planning. Ricoeur's dialogical thinking and description of a person served as an underpinning in discussing and reflecting upon the findings of the interpreted synthesis. Collaborative care planning is a complex process. However, Ricoeur's philosophy contributed to a greater understanding of the collaborative care planning as a person‐centred practice and accentuated that ethics, human values, and the older adults and care partners perspectives need to be given the same importance and considerations as the medical and social sciences perspectives for the collaborative care planning process to truly become person‐centred.