Component Of Patient-centered Care Research Articles

Patient- and family-centred care transition interventions for adults: a systematic review and meta-analysis of RCTs.

Although patient centredness is part of providing high-quality health care, little is known about the effectiveness of care transition interventions that involve patients and their families on readmissions to the hospital or emergency visits post-discharge. This systematic review (SR) aimed to examine the evidence on patient- and family-centred (PFC) care transition interventions and evaluate their effectiveness on adults' hospital readmissions and emergency department (ED) visits after discharge. Searches of Medline, CINAHL, and Embase databases were conducted from the earliest available online year of indexing up to and including 14 March 2021. The studies included: (i) were about care transitions (hospital to home) of ≥18-year-old patients; (ii) had components of patient-centred care and care transition frameworks; (iii) reported on one or more outcomes were among hospital readmissions and ED visits after discharge; and (iv) were cluster-, pilot- or randomized-controlled trials published in English or French. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers. A narrative synthesis was performed, and pooled odd ratios, standardized mean differences, and mean differences were calculated using a random-effects meta-analysis. Of the 10,021 citations screened, 50 trials were included in the SR and 44 were included in the meta-analyses. Care transition intervention types included health assessment, symptom and disease management, medication reconciliation, discharge planning, risk management, complication detection, and emotional support. Results showed that PFC care transition interventions significantly reduced the risk of hospital readmission rates compared to usual care [incident rate ratio (IRR), 0.86; 95% confidence interval (CI), 0.75-0.98; I2 = 73%] regardless of time elapsed since discharge. However, these same interventions had minimal impact on the risk of ED visit rates compared to usual care group regardless of time passed after discharge (IRR, 1.00; 95% CI, 0.85-1.18; I2 = 29%). PFC care transition interventions containing a greater number of patient-centred care (IRR, 0.73; 95% CI, 0.57-0.94; I2 = 59%) and care transition components (IRR, 0.76; 95% CI, 0.64-0.91; I2 = 4%) significantly decreased the risk of patients being readmitted. However, these interventions did not significantly increase the risk of patients visiting the ED after discharge (IRR, 1.54; CI 95%, 0.91-2.61). Future interventions should focus on patients' and families' values, beliefs, needs, preferences, race, age, gender, and social determinants of health to improve the quality of adults' care transitions.

PO-03-155 PATIENT PREFERENCES FOR ADDITIONAL HEALTH CARE INFORMATION AND PARTICIPATION IN SHARED DECISION MAKING IN AN OUTPATIENT CARDIAC ELECTROPHYSIOLOGY CLINIC

Providing health care related information is a component of patient centered care that allows for shared decision making (SDM). Patient preferences for health care information (PPHI) and SDM vary among populations. Understanding PPHI may improve delivery of relevant information, especially for older patients who are seeking care for complex arrhythmic conditions in the time constrained outpatient setting. This study sought to understand patient preferences for participation in SDM and for the amount, format and delivery of additional relevant health information, as well as to explore the influence of select sociodemographic factors. Over four months, a convenience sample of adult patients, prior to their visit in an Electrophysiology (EP) clinic voluntarily completed an anonymous multiple-response survey ranking their preferences for the amount, delivery and format of information, and for their degree of participation in SDM. Bivariate analyses were used to correlate associations between demographic characteristics and PPHI. P values, assuming a significance level of 0.05, were obtained using chi-squared test or Fisher’s exact test, as appropriate. Analyses were performed using (SAS®). Of 202 patients who participated, 76% wished to know most or all information for their condition such as diagnosis, treatment, procedures and complications (Table 1). Apart from face-to-face conversation, printed format was preferred by 83% for additional health information. Approximately 46% preferred their doctor to play a major role in SDM, while 52% preferred equal participation for various aspects of health care (diagnosis, treatment, procedures and risks). These were independent of age or education level. Patients older than 65 were less likely to own a smart phone or seek additional information online, and less likely to prefer a video format. Those who did not complete high school were less likely to have internet access, own a smart phone or search for information from other sources and did not prefer a video format. Understanding patient preferences for delivery and format for additional relevant health care information is essential for SDM in the outpatient EP setting. Advanced age and lower level of education contribute to technological vulnerability of patients and influence patient preferences for additional information and SDM. Health systems should integrate PPHI in the outpatient setting.

Demystifying Prognosis : Understanding the Science and Art of Prognostication.

The science of prognostication is emerging as a vital part of providing goal concordant patient care. Historically, modern medicine has tended to shy away from approaching prognostication as a core clinical skill, and prognosis as something to be shared directly with the patient. In recent years however, the medical field's shift towards a focus on patient autonomy and more openness in matters regarding end of life has propelled the study of prognostication into a more essential component of patient centered care. This calls for more emphasis on teaching the science of prognosis and the skill of prognostication as a core part of modern medical education. The following chapter aims to delve into the science of prognostication, explore the methods of formulating a prognosis, and discuss issues surrounding the communication of prognosis.

598-P: Discussion Recall in Diabetes Care Visits with Young Adults with T1 Diabetes

Introduction: Engagement in and recall of clinical discussions is a key component of patient-centered care. We evaluated frequency and agreement on discussion topics between young adults (YAs) with type 1 diabetes (T1D) and their health care provider (HCP) . Methods: 52 YAs (51.9% female; 48.1% non-Hispanic White (NHW) ; M age = 20.6±1.1 yrs; M T1D duration = 10.9±4.7 yrs; M A1c = 8.2±1.8%) and 9 HCPs (5 MDs; 4 NPs; 100% female) enrolled in a randomized trial to improve health communication skills in YAs preparing for adult T1D care. At baseline, YAs reported demographic information; after the baseline clinic visit, YAs and HCPs separately completed a checklist of topics discussed and rated satisfaction with the visit. Topic frequency and agreement between YAs and HCPs were calculated. Independent samples t-tests and correlations evaluated associations among demographic and clinical characteristics, discussion topics, and agreement. Results: YAs and HCPs had adequate agreement (M = 76.4%; Table 1) . Agreement was not associated with YA gender, age, T1D duration, A1c, or overall visit satisfaction. YAs of color had significantly higher agreement with HCPs than NHW YAs (81.4% vs. 70.8%; t (50) =2.3, p<.05) . Conclusions: Results highlight YA engagement and frequency of developmentally important topics in routine T1D visits. Communication plans may improve frequency of topics raised and recall, and will be evaluated in future research. Disclosure M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.Bryant: None. C.H.Wang: None. R.Streisand: None. Funding American Diabetes Association (1-18-ACE-27) ;

Implementation of a Shared Decision-Making Tool for Osteoarthritis Treatment to Reduce Decisional Conflict

Shared decision making is a key component of patient centered care where clinical evidence and the patient’s preference and values are considered. Physical activity and weight loss are often recommendations in the treatment plan, especially in mild to moderate stage of osteoarthritis (OA). Movement is Life (MIL) created an innovative SDM tool to provide a framework for patient-centered discussions. The tool leverages an underlying Markov Model and represents the likely pain, activity levels, and lost productivity at three future time points. By comparing the patient’s likely progression depending on treatment choices compared to doing nothing, the patient has an illustration of future state. A pilot of N=108 women, ages 45-64, with chronic knee pain for at least three months and at least one co-morbidity (obesity, hypertension, diabetes) were randomized to a control (n=54) or intervention (n=54) arm of the study at eight centers across the United States. Results showed the demographic profiles were similar between the groups. At one-month, n=47 control and n=50 intervention patients returned for evaluation. Self-reported level of physical activity increased in the intervention group (56% vs 34%, p = 0.0229). Qualitative feedback from the intervention group indicated high satisfaction with use of the tool. Both groups reported a high likeliness to recommend the provider to a friend or family member. Inclusion of the SDM tool added an average of one minute to the patient counseling time over the control group. The quasi script provides a consistent communication pathway and may reduce disparities by addressing unconscious bias.

Translation and psychometric evaluation of the German version of the IcanSDM measure \u2013 a cross-sectional study among healthcare professionals

BackgroundShared decision-making (SDM) between patients and healthcare professionals (HCPs) is a key component of patient-centred care. To implement SDM in clinical practice and to evaluate its effects, it is helpful to know about HCPs’ perception of SDM barriers. The measure IcanSDM was developed in Canada and assesses the perception of SDM barriers. To our knowledge, no equivalent measure exists in German. Therefore, the aim of this study was to translate and adapt the IcanSDM measure to be used by a German speaking population and evaluate its psychometric properties.MethodsThis is a cross-sectional psychometric study based on a secondary analysis of baseline data from a SDM implementation study. The original 8-item IcanSDM was translated into German using a team translation protocol. We assessed comprehensibility via cognitive interviews with n = 11 HCPs. Based on results of cognitive interviews, the translated IcanSDM version was revised. Two hundred forty-two HCPs filled out the measure. Psychometric analysis included acceptance (completion rate), item characteristics (response distribution, skewness, item difficulties, corrected item-total correlations, inter-item correlations), factorial structure (confirmatory factor analysis (CFA), model fit), and internal consistency (Cronbach’s α).ResultsWe translated and adapted the German IcanSDM successfully except for item 8, which had to be revised after the cognitive interviews. Completion rate was 98%. Skewness of the items ranged between −.797 and 1.25, item difficulties ranged between 21.63 and 70.85, corrected item-total-correlations ranged between .200 and .475, inter-item correlations ranged between .005 and .412. Different models based on CFA results did not provide a valid factorial structure. Cronbach’s α ranged between .563 and .651 for different factor models.ConclusionWe provide the first German measure for assessing perception of SDM barriers by HCPs. The German IcanSDM is a brief measure with good acceptance. However, we found unsatisfying psychometric properties, which were comparable to results of the original scale. In a next step, the IcanSDM should be further developed and modified and predictive validity should be evaluated.

Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care

BackgroundPatients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates.MethodsQualitative description in a social constructivist/interpretivist paradigm. Participants were purposively sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. Participants engaged in focus group discussions where they expressed their perceptions, views and feelings of an existing PCC model. Data was analysed thematically using a constant-comparison approach.ResultsThree focus groups with 15 patient advocates and three focus groups with 12 GPs were conducted before thematic saturation was obtained. Three themes emerged: i) the model represents the ideal, ii) considering the system and collaborating in care and iii) optimising the general practice environment. The themes related to participants’ impression of the model and new components of PCC perceived to be experienced in the ‘real world’. The data was synthesised to produce an advanced model of PCC named, “Putting Patients First: A Map for PCC”.ConclusionsOur revised PCC model represents an enhanced understanding of PCC in the ‘real world’ and can be used to inform patients, providers and health organisations striving for PCC. Qualitative testing advanced and supported the credibility of the model and expanded its application beyond the doctor-patient encounter. Future work could incorporate our map for PCC in tool/tool kits designed to support GPs and general practice with PCC.

MP12-18 MEDICAL MINIMIZER-MAXIMIZER SCALE (MMS) AND PATIENT PERCEPTIONS OF RESULTS IN A CLINICAL SETTING

INTRODUCTION AND OBJECTIVE:Shared decision making is an important component of patient centered care. Understanding contributors to effective communication, for example, by better understanding pat...

Health-related quality of life and its association with outcomes of outpatient parenteral antibiotic therapy.

While health-related quality of life (HRQoL) is an important component of patient-centred care, few studies have looked at the association between HRQoL and outcomes while on OPAT. From 2014 to 2017, we conducted a prospective cohort study of all patients referred to Singapore General Hospital's (SGH) OPAT service. At baseline, we collected sociodemographic, clinical, and treatment-related factors for OPAT recipients. We also measured baseline HRQoL using the EuroQoL EQ5D-3L. We evaluated the association between HRQoL and the following outcomes: complications experienced while on OPAT, early termination requiring readmission during planned course of OPAT, all-cause readmission 30days after completion of OPAT, and return to work while on OPAT. We used chi-squared test for univariate analysis and cox regression for multivariate analysis. From 2014 to 2017, 1213 patients received OPAT at our centre. Of those, 13.2% (160/1213) developed complications. About 10% (132/1213) of patients were readmitted while on OPAT and OPAT was terminated early. Amongst patients who completed OPAT (N = 1081), about 3.6% (39/1081) were readmitted within 30days after OPAT completion. About half (50.8%, 278/547) returned to work while on OPAT. On multivariate analysis, patients with perfect health-related quality of life (HRQoL) (adjusted relative risk, aRR = 0.62, 95%CI = 0.45-0.85) were less likely to experience complications, had lower risk of OPAT termination (aRR = 0.57, 95%0.38-0.86), and were more likely to return to work while on OPAT (aRR = 1.94, 95%CI = 1.30-2.89). HRQoL at baseline was significantly associated with lower risk of complications and early OPAT termination, as well as greater likelihood of return to work while on OPAT.

Experiences of providers in delivering nutrition-focused lifestyle interventions for adults with obesity or metabolic syndrome in primary healthcare settings: a qualitative systematic review protocol.

The objective of this review is to synthesize the best available evidence regarding primary healthcare provider experiences of delivering nutrition-focused lifestyle modification interventions for adult patients with obesity or metabolic syndrome. There is considerable evidence available regarding the clinical effectiveness of lifestyle modification interventions for diverse patient populations. Primary healthcare providers are well-placed to deliver such interventions as a component of patient-centered care. Perceived lack of appropriate training or skills, confusion about congruence with role and lack of confidence in broaching weight or lifestyle conversations with patients prevents providers from delivering lifestyle interventions in a consistent and effective way. This review will consider qualitative studies that explore the experiences of primary healthcare providers, including nurses, general practitioners and allied health professionals, in delivering nutrition-focused lifestyle interventions, to adults with obesity or metabolic syndrome. Provider experiences can include willingness and approach to discussing weight or lifestyle concerns with patients, clinician self-efficacy, perceived effectiveness and client acceptability of dietary interventions, and beliefs about congruence with clinician role. The search strategy will aim to find both published and unpublished studies from databases including PubMed, CINAHL, Web of Science and Scopus. Studies published in all languages will be considered and those published prior to 2000 will be excluded to reflect current practice in primary health care. Data extracted will include specific details about the populations, context, culture, geographical location, study methods and the phenomena of interest. PROSPERO CRD42019135389.

Patient-centered care via health information technology: a qualitative study with experts from Israel and the U.S.

ABSTRACT Although patient-centered care (PCC) is one of the cornerstones of modern healthcare, the role that health information technology (HIT) plays in supporting PCC remains unclear. In this qualitative study, we interviewed academic and clinical experts from the US and Israel to understand to what extent current HIT systems are supportive of PCC and how PCC should be supported by HIT in the future. A maximum variation sampling approach was used to identify nine experts in both HIT and PCC from clinical and academic settings in Israel and the US. A qualitative descriptive method was used to analyze the interviews and identify major themes. Experts suggested that patient ownership of their disease is a core component of PCC. The majority of the experts agreed that in both Israel and the US, the current situation of PCC implementation is relatively poor. However, HIT should play an important role in making patients owners of their health and treatment and helping providers in delivering better PCC. Central domains of PCC via HIT were providing clear information and support for patients and promoting care that is based on patient values and preferences.

How do specialist trainee doctors acquire skills to practice patient-centred care? A qualitative exploration

ObjectivesThe importance of patient-centred care (PCC) has been increasingly recognised. However, there is limited work exploring what doctors actually understand by PCC, and how they perceive they acquire PCC skills...

OP126 Shared Decision-Making Influences Patients’ Adoption Of Stents In China

Introduction:Shared decision-making (SDM) is an essential component of patient-centered care, involving communication and discussions between physicians and patients on various options to meet their health needs. This study examines the current situation of patients’ participation in decision-making in relation to the clinical application of drug-eluting stents (DES). Further, the impact of patients’ involvement in decision-making on patients' adoption of DES was analyzed, with a view to providing research outcomes to guide clinical practice.Methods:A cross-sectional study was conducted from July to December 2016 in selected hospitals in Fujian Province, Sichuan Province, and Shanghai in China. Patients with coronary heart disease completed a survey, which contained the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) about satisfaction with decision-making processes, and questions on DES. Data were analyzed with cluster analysis, correlation analysis, multivariate logistic regression, and multivariate linear regression.Results:One hundred and seventy-nine patients with coronary heart disease from 15 hospitals in the three regions completed the questionnaire. There were good validity and reliability for SDM-Q-9, with Cronbach's alpha as 0.96 and intra-class correlations 0.59–0.79 (all P < 0.01). Among these respondents, 42.1 percent adopted DES, 83.4 percent were supportive of SDM and 61.33 percent thought they had better communication with physicians regarding decision-making. Patients’ level of SDM involvement was found to be positively associated with their satisfaction with the decision-making process (P < 0.001) and their adoption of DES (P < 0.05). Also, satisfaction with shared decision-making regarding treatment was positively associated with adoption of DES (P < 0.001).Conclusions:Most of the patients with coronary heart disease preferred SDM, and SDM was found to be an important predictor of patients’ satisfaction with decision-making processes and adoption of DES. Better communication between physicians and patients is needed in order to improve patients’ satisfaction and promote the appropriate use of DES technology in China.

Effectiveness of an advance care planning patient navigator on advance directive completion by electronic versus staff-based referrals at a major cancer hospital.

20 Background: Advance Care Planning (ACP) is a central component of patient-centered care, helping ensure patient values and preferences guide clinical decisions. Patient navigators have been utilized effectively in healthcare for numerous roles, and more recently for ACP. At City of Hope National Medical Center (COH), an ACP-focused navigator was hired to support patients, families, and staff with Advance Directive (AD) notarization and primary ACP conversations. Methods: The Department of Supportive Care Medicine at COH with significant institutional collaboration and administrative support created a patient-centered ACP program and marketing campaign, called “Plan Today for Tomorrow.” In 2016, an ACP navigator joined the team to facilitate AD completion. Referral to the ACP navigator occurred either through staff endorsement and/or the institution’s technological screening platform deployed in a majority of COH outpatient clinics. Staff referrals came from physicians, clinical social workers, nurses, or from the Sheri & Les Biller Patient and Family Resource Center. Prior to the ACP navigator, all referrals were addressed by Clinical Social Workers (CSWs). Results: In a review of 14 months of data, the ACP navigator followed up on 1,125 referrals, 574 were from staff, while 551 were from the institutional tablet-based screening platform. Follow-up on staff referrals resulted in an 86% AD completion rate. Follow-up on tablet-based screening resulted in a 23% AD completion rate. Conclusions: The presence of an available onsite ACP-focused navigator was more effective in facilitating AD completion of staff generated AD referrals as compared to AD completion of tablet-based patient screening AD referrals. The presence of the ACP navigator to facilitate AD completion decreased workload for CSWs, creating increased opportunity for CSWs to work at the top of their professional license. Further work is needed to increase the effectiveness of AD completion from tablet-based screening referrals.

The effects of global and targeted advance care planning efforts at a national comprehensive cancer center.

79 Background: Advance Care Planning is a central component of patient centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. Various studies demonstrate advance care planning decreases stress and anxiety, increases satisfaction, improves awareness and implementation of a patient’s end of life wishes, and reduces costs in select populations. At City of Hope (COH) National Medical Center, we made concerted efforts over the last four years to improve the overall number of advance directives(ADs), and have additionally focused on improving AD capture rates in clinically relevant populations (patients undergoing surgery, those with metastatic disease, and those undergoing hematologic transplant). Methods: The Department of Supportive Care Medicine with executive team endorsement and in collaboration with medical oncology, hematology, anesthesia, surgery, nursing, marketing, and informatics created a patient-centric advance care planning program. We developed disease specific workflows, created multi-lingual AD workshops in the Sheri & Les Biller Patient and Family Resource Center, changed policy to provide complimentary patient/caregiver and staff notarizations for ADs, leveraged the electronic medical record (assured providers were able to document discussions, know when ADs were absent, and easily retrieve ADs when present), deploy AD specific screening questions, and most recently created a culturally sensitive branding campaign coined “Plan Today for Tomorrow.” Results: The rate of advance directive capture for all patients new to COH has continuously improved from 12% in 2012 to 22% in 2016. In transplant patients, AD capture rate increased to 63%. In a pilot for bladder cancer patients undergoing cystectomy, ADs were increased to 68%, and in the pre-anesthesia testing clinic, ADs were increased to 35%. Conclusions: We have made significant strides in the capture of advance directives at City of Hope with markedly higher capture rates in selectively targeted, clinically relevant populations. We anticipate improved patient centric care as a result, with the unintended consequence of cost savings and decreased resource utilization.

Patient-centred care to improve dietetic practice: an integrative review.

Patient-centred care (PCC) is associated with significant improvements in patients' health outcomes and healthcare systems. There is an opportunity to better understand PCC in dietetics. Thus, the present integrative review aims to critically synthesise literature relating to PCC in dietetics. A systematic literature search was conducted between February and March 2016. Studies were included if they (i) involved dietitians and/or patients who had participated in an individual dietetic consultation; (ii) related to one or more components of PCC; and (iii) were empirical full-text studies in English, involving adult participants, published between 1997 and 2016. Following title and abstract screening, full texts were retrieved and independently assessed for inclusion by two of the investigators. Two independent investigators conducted data extraction and quality assessment using the Mixed Methods Appraisal Tool. Study findings were analysed thematically using meta-synthesis. Twenty-seven studies met the inclusion criteria. Six themes were discovered inductively: (i) establishing a positive dietitian-patient relationship; (ii) displaying humanistic behaviours; (iii) using effective communication skills; (iv) individualising and adapting care; (v) redistributing power to the patient; and (vi) lacking time for PCC practices. The first three themes were closely related. Studies used a broad range of methodological designs. Limitations of the studies included a lack of reflexivity and a lack of representativeness of the study population. It is apparent that dietitians require good communication skills and humanistic qualities to build positive relationships with patients. Patients strongly desire individualised nutrition care and greater involvement in care. Ensuring dietitians are able to incorporate patient-centred practises during care requires further research.

Lessons learned from the implementation of an online infertility community into an IVF clinic's daily practice

The Internet is expected to innovate healthcare, in particular patient-centredness of care. Within fertility care, information provision, communication with healthcare providers and support from peers are important components of patient-centred care. An online infertility community added to an in vitro fertilisation or IVF clinic's practice provides tools to healthcare providers to meet these. This study's online infertility community facilitates peer-to-peer support, information provision to patients and patient provider communication within one clinic. Unfortunately, these interventions often fail to become part of clinical routines. The analysis of a first introduction into usual care can provide lessons for the implementation in everyday health practice. The aim was to explore experiences of professionals and patients with the implementation of an infertility community into a clinic's care practice. We performed semi-structured interviews with both professionals and patients to collect these experiences. These interviews were analyzed using the Normalisation Process Model. Assignment of a community manager, multidisciplinary division of tasks, clear instructions to staff in advance and periodical evaluations could contribute to the integration of this online community. Interviews with patients provided insights into the possible impact on daily care. This study provides lessons to healthcare providers on the implementation of an online infertility community into their practice.

Delivering on the promise of patient-centered care.

Despite our success in improving survival outcomes in patients with cancer, the words “you have cancer” are still terrifying. These 3 words immediately conjure up the threat of death and the physical and emotional suffering associated with cancer treatments. How well we communicate a cancer diagnosis to patients is at the heart of patientcentered care, but this is only the first of many elements in this process. Patientcentered care is a central tenet of a high-quality cancer care delivery system.1 To the extent that this is highly valued, we must carefully examine how well we are doing in providing this aspect of quality care. “Patient-centered care” has become a popular phrase, along with “personalized treatment” and “precision medicine.” Although most of us think we know what these phrases mean, perhaps taking a minute to examine the intent of each in the context of cancer care is worthwhile. Cancer is a complex and heterogeneous disease that may manifest itself in diverse ways in individual patients. A better understanding of the genetic signature of individual tumors and the characteristics of the host in which the disease resides are nearing possibility, and this highly specific information will (we hope!) allow refinements in the recommended treatments that patients will receive in the future. This may eliminate a one-size-fits-all approach to cancer treatment, and allow for therapeutic modifications that enhance efficacy and potentially reduce toxicity. This is very much the concept behind “personalized” and “precision” approaches to cancer therapeutics.2 In contrast, the concept of “patient-centered care” encompasses a broader swath of the cancer care delivery process in that before patients sign-on to a therapeutic approach for disease management, they must be well-informed about the diagnosis, prognosis, and potential treatment options, having received that information from clinicians with good communication skills that match the unique needs of the patient. In addition, the health care system must be well organized and be able to deliver the chosen care in a timely and compassionate manner, helping the patient avoid unnecessary emergency department visits and hospitalizations. And they must do all of this in a standard manner that ensures it is affordable and part of routine care. No matter how effective precision medicine is in identifying the best treatment for a patient, delivery of this treatment will still require the cooperation of the patient (and family). This requires a patient who is well-informed, can manage treatment side effects, and can follow through on whatever else is prescribed. That is what “patientcentered care” will make possible. Figure 1, taken from the recent Institute of Medicine (IOM) report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,1 shows the close relationship between the components of patient-centered care and improved communication and, ultimately, improved health outcomes. However, delivering this kind of care in our current health care system presents many challenges, largely because of the fragmentation of care (ie, members of the cancer care team not practicing in the same setting). This fragmentation often leads to barriers to effective communication between physicians and resultant gaps in what is communicated to the patient. Patients and their families are often held responsible for communicating recommendations from one physician to another, and this adds a great burden to their experience when they are trying to complete diagnostic tests and make decisions about a treatment plan. The IOM report details many of the challenges inherent in effective patient-centered communication and shared decision-making, focusing Patricia A. Ganz, MD

Development of a Measure to Assess Healthcare Providers’ Implementation of Patient‐Centered Care

Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability. Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items' content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively. The CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC. The PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers' implementation of PCC in their usual practice.

The Role of Shared Decision-Making in Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.