Patient-centered Care Practices Research Articles

Exploring characteristics, predictors, and consequences of fear of cancer recurrence among Asian-American breast cancer survivors.

To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health-related quality of life among Asian-American breast cancer survivors (BCS). A total of 208 diverse Asian-American BCS completed T1 survey, and 137 completed T2 survey after 1year. Fear of cancer recurrence scores (range=0-4) were 2.01 at T1 and 1.99 at T2 reflecting low-to-moderate FCR. Scores of FCR were stable over the 1-year period (t(126)=.144, P=.886). Multiple regression analyses showed that Chinese women reported lower FCR both at T1 (t(193)=-2.92, P=.004) and T2 (t(128)=-2.56, P=.012) compared to other Asian women. Also, more positive health care experience at T1 predicted lower FCR at T2 (β=-.18, P=.041). Controlling for other covariates, greater FCR at T1 predicted poorer outcomes 1year later including lower physical (β=-.31, P<.001), emotional (β=-.37, P<.001) and functional (β=-.16, P=.044) well-being and health-related quality of life specific to breast cancer at T2 (β=-.31, P<.001). We found substantial consistencies and some divergences between our findings with Asian-American BCS and the existing literature. This prospective investigation reveals new information suggesting that Asian-American subgroup variation exists and health care system factors may influence FCR. Thus, FCR studies should consider Asian subgroupings, cultural aspects, ie, level of acculturation and health care system factors including provider-patient communication and treatment setting. Future research may benefit from contextualizing FCR within a broader distress framework to advance the science and practice of patient-centered and whole-person care.

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.

Partnering (with Patients and Families) to Advance the Practice of Patient-Centred Care

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Health professionals’ and patients’ perceptions of patient-centered care: a comparison

Rationale, aims and objectives: This study aimed to compare health professionals’ and patients’ perceptions of patient-centered care (PCC) practice. Methods: PCC was operationalized into three components: (i) holistic, (ii) collaborative and (iii) responsive care. In a cross-sectional design, a sample of 401 health professionals and 500 patients in acute care settings in Ontario, Canada completed a valid and reliable measure of PCC. Results: The results showed that patients had lower ratings of PCC than health professionals, indicating that patients viewed their care as holistic, collaborative and responsive to a low-moderate extent; this contrasted with a more positive view by health professionals, suggesting a high level of PCC enactment (all p’s < 0.05; effect sizes range: 0.38 to 0.88). Discussion and Conclusion: Although methodological, clinical and contextual factors have been suggested, additional research is needed to further explore the mechanisms underlying these differences. Collaboration among management, professionals and patients would promote a collective development of guidelines to deliver PCC.

Connecting Professional Practice and Technology at the Bedside

The purpose of this research is to determine the effects of implementing an electronic health record on medical-surgical registered nurses' time spent in direct professional patient-centered nursing activities, attitudes and beliefs related to implementation, and changes in level of nursing engagement after deployment of the electronic health record. Patient-centered activities were categorized using Watson's Caritas Processes and the Relationship-Based Care Delivery System. Methods included use of an Attitudes and Beliefs Assessment Questionnaire, Nursing Engagement Questionnaire, and Rapid Modeling Corporation's personal digital assistants for time and motion data collection. There was a significant difference in normative belief between nurses with less than 15 years' experience and nurses with more than 15 years' experience (t21 = 2.7, P = .01). While nurses spent less time at the nurses' station, less time charting, significantly more time in patients' rooms and in purposeful interactions, time spent in relationship-based caring behavior categories actually decreased in most categories. Nurses' engagement scores did not significantly increase. These results serve to inform healthcare organizations about potential factors related to electronic health record deployment which create shifts in nursing time spent across care categories and can be used to explore further patient centered care practices.

A Scoping Review on Models of Integrative Medicine: What Is Known from the Existing Literature?

Integrative medicine (IM) has been recognized and introduced into Western healthcare systems over the past two decades. Limited information on IM models is available to guide development of an optimal healthcare service. A scoping review was carried out to evaluate IM models in the extant literature, including the distinctive features of each model, to gain an understanding of the core requirements needed to develop models of IM that best meet the needs of patients. Directed content analysis was used to classify the IM models into systems based on coding schema developed from theoretical models and to identify the key concepts of each system. From 1374 articles identified, 45 studies were included. Models were categorized as theoretical and practical and were subdivided into five main models: coexistence, cooptative, cooperative, collaborative, and patient-centered care. They were then divided into three systems-independent, dependent, and integrative-on the basis of the level of involvement of general practitioners and complementary and alternative medicine (CAM) practitioners. The theoretical coexistence and cooptative models have distinct roles for different health care professionals, whereas practical models tend to be ad hoc market-driven services, dependent on patient demand. The cooperative and collaborative models were team-based, with formalized interaction between the two medical paradigms of conventional medicine and CAM, with the practical models focusing on facilitating communication, behaviors, and relationships. The patient-centered care model recognized the philosophy of CAM and required collaboration between disciplines based around patient needs. The focus of IM models has transferred from providers to patients with the independent and integrative systems. This may require a philosophical shift for IM. Further research is required to best understand how to practice patient-centered care in IM services.

New Graduate Nurses' Developmental Trajectories for Capability Beliefs Concerning Core Competencies for Healthcare Professionals: A National Cohort Study on Patient-Centered Care, Teamwork, and Evidence-based Practice.

This study aimed to describe the developmental trajectories of registered nurses' capability beliefs during their first 3 years of practice. The focus was on three core competencies for health professionals-patient-centered care, teamwork, and evidence-based practice. A national cohort of registered nurses (n = 1,205) was recruited during their nursing education and subsequently surveyed yearly during the first 3 years of working life. The survey included 16 items on capability beliefs divided into three subscales for the assessment of patient-centered care, teamwork, and evidence-based practice, and the data were analyzed with linear latent growth modeling. The nurses' capability beliefs for patient-centered care increased over the three first years of working life, their capability beliefs for evidence-based practice were stable over the 3 years, and their capability beliefs for teamwork showed a downward trend. Through collaboration between nursing education and clinical practice, the transition to work life could be supported and competence development in newly graduated nurses could be enhanced to help them master the core competencies. Future research should focus on determining which factors impact the development of capability beliefs in new nurses and how these factors can be developed by testing interventions.

Preventing Breakdowns in Communication: Teaching Patient-Centered Posthospital Care Transitions to Medical Students.

Patient-centered discharge care is critical to teach in clerkships: Studies have shown that patient-centered discharge care may reduce rehospitalization rates as well as ensure patient understanding after discharge. While these skills are necessary to be a successful intern, this is infrequently taught formally in clerkships. This session introduces medical students to challenges patients and providers face during care transitions, specifically, the transition after discharge from an inpatient hospital stay. This workshop experience fosters the use of best communication-skills practices and team collaboration in discharge education and planning through reflective observation and role-play. Learners first identify common challenges faced when providing effective care transitions and then identify solutions to encourage patient-centered discharge care practices. Students also have the opportunity to be directly observed providing discharge care and to receive feedback using an observation tool. The materials associated with this publication include guidelines for workshop facilitators, blank video worksheet, completed video worksheet, teaching video, role-play exercise instructions and answer sheet for facilitators, direct observation tool, and workshop evaluation form. The majority of students agreed the workshop would be helpful in practicing effective discharge education (69/75, 92%) and in providing patient-centered care during care transitions (72/75, 96%). Observers and students using the discharge education card reported an average score of 4.3 out of 5 that the observation was a helpful educational experience, and 84% of the completed discharge education tools included comments on areas of improvement or an action plan. The tool is brief and user friendly, allowing for this exercise to be completed without difficulty during busy ward days. It also can be completed by residents or attendings depending on time constraints.

Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.

Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting.

Qualitative analysis of US Department of veterans affairs mental health clinician perspectives on patient-centered care.

Enhanced patient involvement in care has the potential to improve patient experiences and health outcomes. As such, large national and global healthcare systems and organizations, including the US Department of Veterans Affairs (VA), have made patient-centered care a primary goal. Little is known about mental health clinician perspectives on, and experiences with, providing patient-centered care. Our main objective was to better understand VA mental health clinicians' perceptions of patient-centered care, and ascertain possible facilitators and barriers to patient-centered practices in mental health settings. Qualitative study of six focus groups conducted in late 2013. Thirty-five mental health clinicians and staff from a large VA Medical Center. Transcripts were analyzed using an inductive and deductive thematic analysis approach. Participants described patient-centered care ideally as a process of shared discovery, and expressed general enthusiasm for patient-centered care. Participants described several ongoing patient-centered care practices but conveyed concerns about the practicalities of its full implementation. Participants expressed a strong desire to change the current biomedical culture and policies of the institution that may hinder clinicians' flexibility and clinician-clinician collaboration when serving patients. In particular, clinicians worried about being held responsible for addressing all of the needs or goals that a patient may identify. If patient-centered care is to be practiced fully in mental health settings, healthcare institutions need to develop multimodal strategies to enhance clinician-clinician and clinician-patient collaborations to promote and support a focus on discovery and shared accountability for outcomes.

Golden Age of Assessment in Pharmacy Education

Nearly 10 years ago, during a meeting to establish university-wide quantitative learning outcomes and assessment measures, a physics faculty member assured the other committee members that, “If we just drag this out long enough it won’t matter anymore (because) this assessment stuff is going away.” In pharmacy education, “this assessment stuff” is definitely not going away. In fact, pharmacy assessment has reached its golden age. Although for some this golden age may appear to be driven by the Center for the Advancement of Pharmacy Education (CAPE) 2013 Outcomes1 and Accreditation Council for Pharmacy Education (ACPE) 2016 Standards,2 the inverse is true, as this assessment prosperity has been growing and building within the academy over the past decade. Just over 5 years ago, the American Association of Colleges of Pharmacy (AACP) established the Assessment Special Interest Group (SIG) with the goal of facilitating faculty exchange of ideas and innovations regarding curricular and programmatic assessment planning and implementation and outcome management. In that short time, the SIG has grown to the third largest in AACP. Recognizing that most schools and colleges only have one designated assessment person, this growth shows that AACP members whose primary responsibility is not assessment recognize the need to increase their own assessment knowledge and skills. As another means to increase assessment knowledge and skills, academy members are increasingly attending the annual AACP institutes. As far back as the 2007 Assessment Institute at Lansdowne, Virginia, and Snowbird, Utah, institutes have included assessment components regardless of the primary topic. In 2015, AACP Annual Meeting programming included 20 distinct sessions and mini-sessions on assessment topics, doubling from 2009 and representing a quarter of all educational sessions at the meeting.3 Educational programming is not the only area in which assessment’s golden age is noted; governance and initiatives are aiming to establish stronger quality assurance measures through validated tools. The association has worked with its membership to develop and launch curriculum quality surveys that provide national and peer school benchmarks in perceptions of student, faculty, alumni, and preceptors to all member institutions. During the 2015 AACP House of Delegates, the need for stronger assessments and links between licensure and assessment were emphasized through the resolution that AACP lead collaborative efforts to produce evidence-based assessments mapped to current CAPE Outcomes.4 While some perceive that assessment efforts are entirely driven by accreditation, the overall trend toward accountability in higher education, particularly in the health professions, has influenced the revision of the ACPE Standards in 2007 and in 2016, which involves the members of the academy and other stakeholders. These revisions highlight the importance of continuous quality improvement, engagement of all stakeholders, and the transparency and availability of assessment data. Although this is a time of prosperity for assessment, we are far from our pinnacle. What else needs to be done? First and foremost, despite having only one person assigned to assessment at most institutions, it is not a one-person job. Along with ensuring sufficient administrative and staff support, schools need to develop cultures of assessment in which all faculty members appreciate their role in curricular and programmatic assessment. Deans and administrators need to provide leadership in assessment to engage faculty members, staff, students, and stakeholders. Beyond support of an assessment culture, part of this leadership requires administrators to encourage faculty members to validate their assessment instruments to ensure the tools assess what they claim to measure. This leadership also requires that measures beyond student perceptions be used to evaluate achievement of learning outcomes. Collaboration among similar schools also will serve to advance assessment. Many schools have formed consortiums or other collaborative groups, which advance knowledge among members, establish and share practices for meaningful data collection and use, validate assessment tools, and advance scholarly pursuits. Not only is “this assessment stuff” not going away, it is here to stay and flourish. The academy has embraced the culture of continuous quality improvement and accountability to prepare our graduates for entry into practice and provision of patient-centered care as members of a health care team. Now is the time to join the assessment efforts as we move onward and upward during this time of assessment prosperity. Don’t get left behind.

From Dyadic Ties to Information Infrastructures: Care-Coordination between Patients, Providers, Students and Researchers. Contribution of the Health Informatics Education Working Group.

To share how an effectual merging of local and online networks in low resource regions can supplement and strengthen the local practice of patient centered care through the use of an online digital infrastructure powered by all stakeholders in healthcare. User Driven Health Care offers the dynamic integration of patient values and evidence based solutions for improved medical communication in medical care. This paper conceptualizes patient care-coordination through the lens of engaged stakeholders using digital infrastructures tools to integrate information technology. We distinguish this lens from the prevalent conceptualization of dyadic ties between clinician-patient, patient-nurse, clinician-nurse, and offer the holistic integration of all stakeholder inputs, in the clinic and augmented by online communication in a multi-national setting. We analyze an instance of the user-driven health care (UDHC), a network of providers, patients, students and researchers working together to help manage patient care. The network currently focuses on patients from LMICs, but the provider network is global in reach. We describe UDHC and its opportunities and challenges in care-coordination to reduce costs, bring equity, and improve care quality and share evidence. UDHC has resulted in coordinated global based local care, affecting multiple facets of medical practice. Shared information resources between providers with disparate knowledge, results in better understanding by patients, unique and challenging cases for students, innovative community based research and discovery learning for all.

Deeper Learning through Service: Evaluation of an Interprofessional Community Service-Learning Program for Pharmacy and Medicine Students

Abstract Background This Community Service-Learning Project (CSLP) at the University of Saskatchewan is designed to help students develop patient-centred care practices in urban underserved settings. First-year medical and pharmacy students partner interprofessionally to both learn and serve, working with community-based organizations (CBOs) that primarily serve either low-income or newcomer residents of Saskatoon. Since the CSLP’s pilot year in 2005-2006, 98 first-year medical and pharmacy students have participated in the CSLP. Methods and Findings We evaluated the outcomes and processes of the CSLP since the 2006-2007 year, using mixed methods: end-of-project questionnaires; document analysis looking for key and recurrent themes; end-of-project semi-structured interviews with CBO coordinators and clients. We examined students’ experiences, including satisfaction, achievement of learning objectives, learning processes, and perceived outcomes. Students’ main learning outcomes related to client-centered approach, interprofessional attitudes and skills, and personal development. Various learnings related to program processes are reported. Conclusions Our evaluation reinforced findings from the literature on both interprofessional education and community service-learning, as well uncovering some new findings. Students described a transformative learning experience that helped them begin to develop understanding and skills to work more effectively with clients in urban underserved settings.

Exploring the practice of patient centered care: The role of ethnography and reflexivity

Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams (“dyadic” and “organizational”) and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from “practice theories” and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and benefits of our approach through a hospital case study.

Emerging themes in using narrative in geriatric care: Implications for patient-centered practice and interprofessional teamwork

Narrative approaches are increasingly used with older adults by different health professionals in a variety of care settings to provide unique and powerful insights into the patient's lifeworld and the meaning of their illness. Understanding these approaches requires insight into the narratives of both the patient and the provider. Different health professions have differing attitudes toward aging and are socialized into distinct ways of framing the problems of older adults. In a patient assessment, they may co-construct different stories that create the basis for interprofessional collaboration, posing challenges for communication among members of the team. This paper develops a conceptual framework for characterizing the use of narrative as the development of sets of “voices” reflecting a dynamic interaction between the provider and the patient, including the use of master narratives, stories and counterstories, and plots and subplots. The literature on the use of narrative with older adults in the professions of medicine, nursing, and social work is reviewed comparatively to develop a typology of these professional differences and the basis for them. Implications and recommendations for the development of new models of patient-centered care and interprofessional practice with older adults are developed.

Time for Consensus on a New Approach for Assessments

Time for Consensus on a New Approach for Assessments

The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

Review question/objective The objective of this systematic review is to synthesize the eligible evidence of patients’ experience of engaging and interacting with nurses, in the medical-surgical ward setting. This review will consider the following questions: What are the expressed experiences of patients engaging and interacting in patient-centred communication with nurses? What are the beliefs, opinions and desires of patients, when engaging and interacting with nursing staff in terms of communicating in ways that meet the patients’ needs and wants? What factors do patients perceive influence (facilitate or prevent) patient-centred communication and their engagement and interaction with nursing staff? What are the experiences of patients of nurses listening to and responding to them within patient-centred communication with respect to their safety and experience of care? Inclusion criteria Types of participants The review will consider studies that include adult patients who are 18 years of age and older who have been admitted as inpatients to a medical-surgical ward. Studies and texts presenting adult inpatients to all other hospital wards settings will be excluded. Maternity, emergency department, operating room, palliative and psychiatric ward settings will be excluded. Emergency department settings are excluded as they may not include patients that are admitted to hospital. Operating room settings are excluded because of the variations in the level of consciousness that may occur to patients. Maternity, palliative care and psychiatric patients because of unique needs of care required by these patients. Studies that include patients with cognitive disorders will also be excluded. Phenomena of interest This review will consider studies that investigate patient experience of engaging and interacting with nurses at the bedside in the hospital setting and the meaningfulness of that experience.

NT-05 * PATIENT ACCEPTANCE OF ROUTINE RESAMPLING OF GLIOBLASTOMA: A QUALITATIVE STUDY

INTRODUCTION: The routine resampling of glioblastoma may be very useful to guide patient care after initial surgery, radiation, and chemotherapy, akin to bone marrow biopsy in leukemia patients. Qualitative research methodology was used to explore the views of patients on this issue. Qualitative research is a form of social sciences investigation, focusing on the experiences of participants in real, not experiment settings. It has not been used much by clinicians, especially neuro-oncologists, but this is slowly changing. METHODS: 30 patients with glioblastoma were recruited from a neuro-oncology clinic in a cancer center serving three adult teaching hospitals. The protocol was passed by the IRB. The study subjects were given semi-structured interviews using an interview guide, and the recorded data assessed using modified thematic analysis and grounded theory. Overarching themes were extracted from the data. RESULTS: Several themes arose - the primary and most important was that routine resampling of glioblastoma was acceptable to most patients. CONCLUSIONS: Using qualitative research methodology, we can learn insights about patients' experience that we cannot learn from quantitative research. This information can help us learn: 1) what our patients are feeling; 2) how we can better talk to them; 3) what issues are important to them to talk about; 4) how we can improve their care and their perception of care; and 5) how we can better conduct clinical research. This can lead to improvement in the quality of our neuro-oncology patients' experience and help facilitate the practice of patient-centered care for brain tumor patients. This particular study demonstrates that routine resampling of glioblastoma is acceptable to patients, and more generically, it represents a novel way of assessing if innovative treatments would be acceptable to the patients they are designed for by directly asking patients for their views.

Patient-centred care: barriers and opportunities in the dental surgery.

This paper explores the practice of patient-centred care (PCC) within dentistry. The aim of this research was to explore the barriers and opportunities dentists face in practicing PCC. The results of N=20 thematically analysed, in-depth semi-structured qualitative interviews with a range of dentists working across clinical and teaching positions within a large UK dental school are presented. PCC was generally considered a positive, to be embraced concept which dentists believe they practice daily in the absence of any formal training. PCC presented dentists with opportunities to deliver treatment to highly compliant patients. The main barriers revolved around patients (e.g. disengaged or overly inquisitive) and practice factors (e.g. time and funding). PCC is a concept that is generally seen as important in the dental surgery, presenting dentists with opportunities for compliance-enhanced practice. Significant work is needed if dentists are going to be supported in overcoming self-identified barriers to their delivery of PCC as per UK General Dental Council guidelines.

The Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE): meeting the challenge of interprofessional education.

Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in today's health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes.