Patient-centred Clinical Method Research Articles

High-quality patient-centered palliative care: interprofessional team members’ perceptions of social workers’ roles and contribution

ABSTRACT A core tenet of interprofessional collaborative practice (IPCP) is that efficient and effective teams are critical for the delivery of high-quality, patient-centered care. Although palliative care has a history of excellent care, increasing demands and larger patient loads are challenging teams to adapt and strengthen team functioning in hospital settings. The purpose of this qualitative study was to better understand the IPCP contributions of advanced palliative social workers (PSWs) through the eyes of their colleagues. Twenty-four interprofessional palliative care (IPPC) team members from other professions (i.e. nurse practitioners, physicians, physician assistants) from 16 hospitals across the U.S. participated in 20-minute semi-structured interviews. The Patient-Centered Clinical Method (PCCM) was used as a conceptual model to aid in the interpretation of the data. This model illuminated the centrality of PSWs’ role in building and sustaining a therapeutic alliance between the patient and the IPPC team, through assessing and promoting care that centers the patient’s experience with illness, creating space to initiate, process and revisit difficult healthcare conversations and helping to modulate the pace and intensity of emotionally laden discussions. PSWs also support the therapeutic relationship with the IPPC team by providing continuity and connection across and during the hospital experience and supporting the well-being of the IPPC team. This study offers novel insights into how PSWs contribute to patient-centered IPPC and furthers the articulation of the role of PSWs in hospital settings.

El nuevo programa de la especialidad de medicina familiar y comunitaria: una oportunidad que no se debe perder

The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development.To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible.It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.

Comparison of patients' perceptions of family physicians' patient-centeredness between virtual and in-person clinical encounters: A cross-sectional study.

A clinician's patient-centeredness is a core construct of quality healthcare and is associated with several positive patient outcomes. This study aimed to compare patient-perceived patient centeredness between in-person and virtual clinical encounters during the coronavirus pandemic. Participants completed an online anonymous questionnaire pertaining to a recent clinical encounter. Patients of an academic family medicine teaching clinic scheduled for either an in-person or a virtual clinical encounter were recruited by phone over a two-month period. Using the patient-centered clinical method as a conceptual framework, patient-perceived patient centeredness was measured by the Patient-Perceived Patient-Centeredness Questionnaire-Revised (PPPC-R), consisting of 18 items that reflect three factors (healthcare process, context and relationship, and roles). The sample consisted of 72 participants. There was no difference in the PPPC-R scores between participants who received in-person and those who received virtual care. However, the mean ranks for the PPPC-R total score and for all three factors were higher for participants who saw a family physician compared to participants who saw a family medicine learner. Family physicians provided similar quality healthcare, measured through a patient-perceived patient-centeredness lens, via both virtual and in-person appointments. These results support sustaining virtual care when deemed appropriate by both patient and clinician.

Hasta Merkezli İletişim Ölçüm Aracının Değerlendirici İçi ve Değerlendiriciler Arası Güvenilirliği

Introduction: The patient-centered clinical method allows the biopsychosocial model to be implemented in clinical practice. It is critical to look at the use of the patient-centered clinical method, which has been shown to benefit both patients and clinicians, particularly in primary care. The Measure of Patient-Centered Communication (MPPC) is a theory-based instrument for assessment of patient-physician interaction. The aim of this research is to investigate the inter- and intra-rater reliability of the MPCC tool in Turkish. Methods: Audiovisual recordings of 60 patient-physician consultations of 30 family physicians were evaluated. Three researchers independently assessed and scored these interviews with MPCC by following the instructions in the manual of the tool. Evaluators reassessed the randomly selected 20 consultations 15 days later to determine the intra-rater reliability. For each component score and the overall score, ICC estimates, and their 95% confidence intervals were calculated based on a mean-rating (k=3), consistency, 2-way mixed-effects model. Results: The ICCs for overall score and component one were 0.810 and 0.820, respectively, for all 60 consultations, demonstrating strong inter-rater reliability. Components two and three had ICCs of 0.646, indicating strong reliability, and 0.537, indicating moderate reliability. All researchers' intra-rater correlation scores for all score groups ranged between 0.989 and 0.698, indicating good to excellent reliability. Conclusions: MPCC tool is reliable in its current form as it is translated into another language and conducted in another sociocultural environment.

Planetary health action framework: A case study

Planetary Health (PH) action is urgent to avoid the collapse of Earth's systems that sustain human health. PH care has been proposed as an approach to improve health equity and reduce healthcare´s ecological footprint. This paper presents the conceptual framework of patient-centered PH care as essential for PH action at the community level. We examine and reflect on one primary care clinical case through 8 lenses: 1) Actor-Network Theory, 2) Evidence-based medicine, 3) Patient-Centered Clinical Method; 4) Principles of Primary Care, 5) Proposed new primary care derivate principle of PH care, 6) the WONCA´s (World Organization of Family Doctors) core competencies tree, 7) WONCA´'s curriculum, and 8) Sustainable Development Goal 3. This case offers insights into functions of primary care that mitigate, adapt and build resilience to the challenges of climate emergency and Anthropocene. It “connects-the-dots” to propose a new identity of primary care, elaborate a blueprint for patient-centered PH care and a roadmap for PH action at the community level.

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program.

Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.

Potential of a cognitive-behavioural approach to improve patient symptoms in a primary care setting.

Family medicine residents in Canada are trained to use a patient-centred clinical method when evaluating patients who present to them with particular symptoms.[1][1] This approach uses a biomedical evaluation as well as consideration of patients’ perspectives and concerns. As a result, patients

Role of physicians' attributes in the production of the person-centered approach in primary health care

Even though several factors influence the medical approach, there is few research examining the association of characteristics at the doctor's level with the kind of practice developed by this provider. This study aims at establishing the factors that, at the doctor's level, are associated with the high degree of patient-centered clinical method (PCCM) orientation assigned by the cared persons to the approach of this provider in primary health care (PHC). This cross-sectional study was conducted with hypertensive or diabetic patients and doctors in the 12 health care centers of a PHC service in Porto Alegre (RS), Brazil. The "Patient Perception of Patient-Centeredness" (PPPC) tool was used to measure the degree of PCCM orientation. The variables concerning the doctor's age, gender, time since graduation, service and unit seniority, and participation in continuing education outside the studied service were correlated with the median of the PPPC general score estimated for each professional. We also found a significant difference in the comparison between the medians of the PPPC general score in each health care center. We discuss the influence of professional experience, gender, continuing education, and the context on the approach developed by the doctor.

Using Authentic Chinese Doctor-Patient Consultations to Develop Patient-Centered Communication Skills

Researchers in Languages for Specific Purposes (LSP) have suggested the importance and benefits of using authentic spoken workplace discourses as teaching materials to develop students’ communication skills in professional settings. However, LSP course designers are still facing the challenges of selecting and collecting authentic workplace conversations, as well as designing instruction to teach the occupational spoken discourses effectively. To address these challenges, this paper presents an innovative module for Chinese for Medical Purposes for pre-med college students at the intermediate-high level. The module uses authentic doctor-patient consultations and adopts the Patient-Centered Clinical Method (PCCM) of Stewart et al. (2014), a clinically validated model in healthcare communication research. The current module demonstrates the approach to determine the student learning objectives based on the PCCM model and the instruction design aiming at guiding students to notice and analyze the discourse features and communication strategies employed by physicians to achieve patient-centered care. The paper also examines learners’ pre- and post-instruction roleplay performances. The qualitative findings show that the learners improved in using patient-centered communication strategies after instruction.

Evaluation of training effects in the person-centered clinical method through active methodologies

Abstract The Patient-Centered Clinical Method (PCCM) recognizes the particularities of each person who falls ill and values the therapeutic role of the doctor; promotes a holistic approach to the patient and / or the disease in its context; highlights the reasoning and decision-making process leading to the diagnosis taking into account the patient's expectations, feelings and fears. The proportion of patients who remain without a specific diagnosis is high because the clinical conditions present with nonspecific symptoms and the patient's understanding is the key to understanding. The challenge that is faced is training professionals with these skills and competences. The PCCM is an approach that respects the patient's preferences and in which communication has an effect on health outcomes, through self-confidence and motivation for change that can contribute to adherence and self-care. This work aims to present an experience of training new professionals at PCCM based on active methodology and mentoring in which the student himself is a source of reflection and study. The course was taught within the Residency Program in Family and Community Medicine in the Municipality of Vitória da Conquista, Bahia, Brazil, developed in 9 meetings of 4 hours each with themes such as, family, life cycle, genogram, ecomap, sexuality, death, diagnostic disclosure, ICU experience, psychosomatics. Many group dynamics and participatory techniques were used to enable involvement, at the end of the course they were asked to evaluate it, the writings were analyzed qualitatively through discourse analysis. The students showed a great willingness to bring their own experience of illness and style of illness, producing a greater empathy with the patient's condition. Trained professionals change from the authority paradigm to that of partnership, solidarity, empathy and collaboration. Training at the PCCM is a differential in the quality of care of any health professional. Key messages Allows to get closer to the user, facilitates understanding his problems and propose the developing joint strategies or plans - based on your expectations, limitations, feelings. PCCM tools contributed to the structuring of the clinical consultation in Primary Health Care (PHC), valuing the listening and the use of open questions.

Um roteiro de entrevista clínica centrada na pessoa para a graduação médica

O ensino de habilidades de comunicação clínica na graduação médica encontra nos princípios e componentes do Método Clínico Centrado na Pessoa (MCCP) uma referência importante para a definição de suas competências. No entanto, mesmo tendo contato com o MCCP em sua formação, é frequente que estudantes de medicina recorram à utilização da anamnese tradicional centrada na agenda médica como um roteiro mais seguro para realização de suas entrevistas. Propomos, como uma hipótese para essa dificuldade dos estudantes, a falta de uma tradução do MCCP em um roteiro padronizado de entrevista médica, especialmente para ensino na graduação. Neste relato, a partir de modelos de entrevista clínica centrada na pessoa (ECCP) selecionados da literatura internacional, apresentamos a primeira etapa de um roteiro de ECCP original, adaptado ao cenário brasileiro. O objetivo deste relato é oferecer uma referência de fácil utilização em língua portuguesa e que possa ser aprimorada pelos profissionais envolvidos com o ensino de comunicação clínica na educação superior no Brasil. Estudos empíricos ainda são necessários para endossar uma utilização mais ampla da proposta aqui apresentada.

The revised Patient Perception of Patient-Centeredness Questionnaire: Exploring the factor structure in French-speaking patients with multimorbidity.

BackgroundThe Patient Perception of Patient‐Centeredness (PPPC) questionnaire was revised, and there is a need for the questionnaire to be tested in diverse primary care populations.ObjectivesThis study aimed to examine the factor structure of the Revised PPPC questionnaire (PPPC‐R) in French‐speaking patients with multimorbidity.DesignSecondary analysis from baseline data of the French arm of Patient‐Centered Innovations for Persons with Multimorbidity Study (PACEinMM Study).Setting and participantsParticipants were adult patients with multimorbidity attending primary health‐care settings.Outcome measuresExploratory factor analyses were applied to examine the factor structure of the PPPC‐R. Cronbach's alpha values were calculated to assess the internal consistency of the whole questionnaire and of each factor explored.ResultsThere were 301 participants, mean age 61.0, 53.2% female. The PPPC‐R showed very good internal consistency, with three factors: Patient‐Centered Clinical Method (PCCM) Component 1‐Exploring the health, disease and illness experience + PCCM Component 4‐Enhancing the patient–clinician relationship (Factor 1); PCCM Component 2‐Understanding the whole person (Factor 2); and PCCM Component 3‐Finding common ground (Factor 3). There was a good internal consistency within each factor (Cronbach's α = 0.87 for 8 items in Factor 1, 0.77 for 5 items in Factor 2 and 0.87 for 5 items in Factor 3).Discussion and conclusionsThe French PPPC‐R factor structure was in accordance with the underpinning conceptual model and presented with three factors. Further assessment of its validity and reproducibility are needed to allow its use as a measure of patient's perception of patient‐centeredness.

Exploring the therapeutic alliance in Belgian family medicine and its association with doctor–patient characteristics: a cross-sectional survey study

ObjectivesPatient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is...

Interview and Health History: critical analysis of the various authors and proposal of a consultation guide and record based on the Patient-Centered Clinical Method

Interview and Health History: critical analysis of the various authors and proposal of a consultation guide and record based on the Patient-Centered Clinical Method

Implications of a Novel Method for Analyzing Communication in Routine Veterinary Patient Visits for Veterinary Research and Training.

The patient-centered clinical method (PCCM), a model developed to characterize communication during patient-physician visits in the 1980s, identifies elements of patient-orientated, physician-orientated, and shared dialogue during the encounter. The model also includes elements that reflect the emotional aspects of these interactions, recognizing expressions of feelings and exchanges related to both personal and medical interests. Fifty-five routine veterinary patient visits in the United Kingdom and United States were analyzed using the novel application of a PCCM adapted for veterinary patient visits. The patient visits were video recorded, transcribed, coded, and analyzed for frequency and proportion of PCCM elements observed. Elements representing the greatest proportion of patient visits were related to gathering information and shared decision making. Those representing the smallest proportion were related to signs of the presenting condition and effects of the condition on the clients' lives. Dialogue during the patient visits flowed iteratively and back and forth between the veterinarian and the client perspective. The findings suggest that patient visits are focused more on gathering information and planning rather than exploring effects of the health problem on the client's life, and that patient visits flow very iteratively and randomly between veterinarian and client perspectives. Both of these topics should be studied further and given emphasis in the way that communication models are developed and taught in order to enhance client-centeredness in veterinary patient visits.

Measuring Patients' Perceptions of Health Care Encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire.

Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCCM framework led to a corresponding need to enhance the Patient Perception of Patient-Centeredness (PPPC) questionnaire. The original PPPC was aligned with the components of the PCCM conceptual framework and developed to measure patient-centeredness from the patient's perspective. The purpose of this study was to examine the factor structure of a revised version of the PPPC (ie, PPPC-R). Eleven new items were added to the original 14 items. The modified questionnaire was administered to patients in primary health care teams in Ontario, Canada. The confirmatory factor analysis was conducted on a subset of 381 patients who had seen a family physician. The initial proposed 4-factor model first tested with a confirmatory factor analysis (CFA) did not fit adequately. Exploratory factor analysis was therefore used as a second step to modify the model and to identify weak items. A 3-factor exploratory model with 18 of the original 25 items was converted into a final hypothetical CFA model that had a good fit (χ2 (132)=176.795, P<0.01; CFI=0.991; RMSEA=0.030). The third factor contained only 2 items and so is interpreted with caution. The validity of the PPPC-R is supported by some congruence between the conceptual framework (the PCCM) and the statistical analysis (CFA), but there is not a 1:1 correspondence. The components of the PCCM represent conceptually what is important when teaching, researching, and providing patient-centered care, whereas the PPPC-R represents patient-centered care as it is experienced by the patient.

‘I’ve put diabetes completely on the shelf till the mental stuff is in place’. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study

Objective: This paper investigated patients’ experiences of disease and self-care as well as perceptions of the general practitioner’s role in supporting patients with impaired self-care ability.Design: Qualitative interviews with 13 patients with type 2 diabetes, concurrent chronic diseases, and impaired self-care ability assessed by a general practitioner. We analyzed our data using systematic text condensation. The shifting perspectives model of chronic illness formed the theoretical background for the study.Results: Although most patients experienced challenges in adhering to recommended self-care activities, many had developed additional, personal self-care routines that increased wellbeing. Some patients were conscious of self-care trade-offs, including patients with concurrent mental disorders who were much more attentive to their mental disorder than their somatic diseases. Patients’ perspectives on diseases could shift over time and were dominated by emotional considerations such as insisting on leading a normal life or struggling with limitations caused by disease. Most patients found support in the ongoing relationship with the same general practitioner, who was valued as a companion or appreciated as a trustworthy health informant.Conclusion: Patient experiences of self-care may collide with what general practitioners find appropriate in a medical regimen. Health professionals should be aware of patients’ prominent and shifting considerations about the emotional aspects of disease. Patients valued the general practitioner’s role in self-care support, primarily through the long-term doctor-patient relationship. Therefore, relational continuity should be prioritized in chronic care, especially for patients with impaired self-care ability who often have a highly complex disease burden and situational context.Key points Little is known about the perspectives of disease and self-care in patients with a doctor-assessed impaired ability of self-care. • Although patients knew the prescribed regimen they often prioritized self-care routines that increased well-being at the cost of medical recommendations. • Shifting emotional aspects were prominent in patients’ considerations of disease and sustained GPs’ use of a patient-centred clinical method when discussing self-care. • Relational continuity with general practitioners was a highly valued support and should be prioritized for patients with impaired self-care.

Approaching Spirituality Using the Patient-Centered Clinical Method.

Although the scientific literature already suggests the importance of spiritual care in clinical practice, this topic has been apart from the routine of many practitioners, and many physicians still have difficulties in how to carry out such approaches in the clinical setting. This article reflects on the importance of spirituality in the health-disease process and provides an approach to the biopsychosocial-spiritual care in the practice of primary care. In addition, the aim of the authors is to propose a spiritual approach based on the patient-centered clinical method. This method has been used for clinical communication and can be powerful for exploring spiritual history. Thus, using a fictional case scenario as a practical example, the authors guide readers to understand the patient-centered approach they propose.

General practitioners' strategies in consultations with immigrants in Norway-practice-based shared reflections among participants in focus groups.

Immigrants comprise 16.8% of the population in Norway and meet General Practitioners (GPs) as their first point of contact with most health care services as do others in Norway. While Norwegian GPs are not trained in cultural competence, little is known about the extent to which they see good care for immigrants as relying on specific strategies. To explore the thoughts of GPs in Norway about strategies they might use with immigrant patients. We performed focus groups posing the question 'What strategies do you use when meeting immigrant patients?' to three groups of GPs working in Norway. Two groups comprised 10 trainee GPs each; the final group comprised eight certified GPs. Verbatim transcripts were analysed by systematic text condensation. Strategies for consultations with immigrants emerged gradually throughout the focus groups, coalescing around (i) Respect and learn about immigrant culture. (ii) Particularize diagnosis and care, accommodating epidemiological and cultural knowledge for a given group, while keeping a keen eye on the individual. (iii) Inform about Norwegian health care. (iv) Organize resources such as time, translators and interdisciplinary teams. Other core elements of cultural competence, including reflections on the GP's own cultural background, were conspicuously absent, however. Given the growing numbers of immigrants and the early transfer of refugees to general practice, our study points to the urgent need of supplementing teaching in patient-centred clinical method with cultural competence. Our study also highlights the potential of educational GP groups to develop strategies for cross-cultural consultations.

'El Carmel' community-orientation experience

Introduction: “El Carmel” health center is located in a social deprived area in Barcelona city with around 20000 inhabitants. Since the Spanish reform of the primary health care in 1984, Primary Healthcare Centers (PHC) have to provide healthcare services for individuals, families and the assigned. However the reality is that the majority of PHC focus their practice into individuals, and care is frequently left in oblivion. Here we present the strategy to progressively orient our practice to the community. Description of practice change implemented: Our project aim is to improve the health of the as a whole, empowering citizens to face their own problems, beating against health inequities and creating a healthier neighborhood. Goals are: to achieve a health diagnosis and to implement health programs based on priorities agreed We identified three eligible situations: 1. In the medical/nurse consultation, using the patient-centered clinical method, contextualizing the health demands and looking for a salutogenic approach when possible. 2. At the PHC level we conducted a health diagnosis, and established priorities of action. 3. In the PHC outreach activity, we collaborate with the Neighborhood-Community-Project (NCP) in which are represented the main local citizen associations, the local government and other public and private services included social services. Key findings: In 1994 the PHC team began a orientation in a very slow pace, facing internal and external constraints. a) In 2000 we finished a health diagnosis (quantitative and qualitative). The document was updated in 2004 with a list of priorities b) In 2000 the NCP invited us to participate to developing a strong social network and promoting the engagement. From 2004 until 2014 the NCP has developed a wide range of activities in which the PHC has participated, especially when related to health promotion. This process follows the community plans methodology. c) From 2005 to 2012 a child-obesity program has been implemented to improve healthy food habits and an active life style. This program follows the Community-Oriented-Primary-care methodology. Health outcomes: significant improvement in life-style (from 40% to 61%) and quality of diet (from 52% to 64%) d) Since 2004 a walking group project for people over 65 has been developed, especially for those at risk of social isolation. At this moment we have 6 walking groups with around 150 participants. The project follows the Participatiory-Action-Research methodology. Health outcomes: significant decrease in blood pressure (from 136,7 to 131,3 for systolic blood pressure and from 75,6 to 73,2 for dyastolic) and even more in patients over 70 yo. e) In 2014 the NCP decides to engage issues on health inequities. In March 2015 we presented a short illustrated book explaining the role of social factors in the neighborhood health. We look forward using them in future events (schools, local associations). f) In September 2014 a choral group was formed with patients affected by chronic conditions with the aim to improve quality of life. A 6 months clinical trial has showed an improvement in the quality of life and the participants expressed great interest to continue with the activity. Nowadays there are around 25 participants and the group has started to sing in events. g) In 2015 the PHC joined the ‘COMsalut' project. The aim of this project is to facilitate and recognize the work of the PHC in Catalonia. h) At this time we are working in a data base of assets and preparing a basic set of socioeconomic data to include in the individual electronic health record. Highlights: The main constraints for the orientation has been the lack of knowledge in engagement; the overload of work in consultation; the few recognition of the work and the pressure of the employer to achieve goals in clinical area. We have been developing a close relationship with different partners of the NCP and we’ve been progressively improving our competences in and groups work. We have realized along these years that the presence of the PHC in events or activities is a tool to gain citizens interest. We have developed the ability to accompany various groups and slowly let them gain autonomy. Joining the ‘COMsalut’ project has been a good resource to face eventual problems in future. Conclusion: The orientation of the PHC team is an important contribution to face social and health iniquities of a defined community. With the support of our employer and the recognition of these activities as a part of the assigned work task, the orientation of the primary care services could be sustainable. We think our experience is not unique and in any case is transferable to other practices with a similar context.