Principles Of Person-centred Care Research Articles

HCA PIECESTM Care Coach Program: Peer to peer approach to promote person-centred care in long-term care

In Long-Term Care (LTC) settings, the potentially inappropriate use of antipsychotics for behavioural and psychological symptoms of dementia is a persistent issue, with high rates despite limited benefit and serious risk. Best practice is a non-pharmacological, person-centred approach to care, though this can be challenging in LTC settings. To help address this gap, we developed the PIECESTM HCA Care Coach Program and described its implementation and outcomes observed at 13 LTC homes. This program empowers Health Care aides with training, tools, and processes to practice the principles of person-centred care and provide peer mentorship to the care team. After 1 year, we found declining antipsychotics use (by 4.4%) and positive indicators of improved staff experience and improved resident quality of life. The Care Coach Program can be adapted and spread to a variety of LTC settings to help reduce potentially inappropriate antipsychotic use and better support people living with dementia.

Registered nurse case managers’ work experiences with a person-centered collaborative healthcare model: an interview study

BackgroundMultimorbidity is increasingly acknowledged as a significant health concern, particularly among older individuals. It is associated with a decline in quality of life and psychosocial well-being as well as an increased risk of being referred to multiple healthcare providers, including more frequent admissions to emergency departments. Person-centered care interventions tailored to individuals with multimorbidity have shown promising results in improving patient outcomes. Research is needed to explore how work practices within integrated care models are experienced from Registered Nurse Case Managers’ (RNCMs) perspective to identify areas of improvement. Therefore, the aim of this study was to describe RNCMs’ work experience with a person-centered collaborative healthcare model (PCCHCM).MethodsThis study used an inductive design. The data were collected through individual interviews with 11 RNCMs and analyzed using qualitative content analysis.ResultsData analysis resulted in four generic categories: ‘Being a detective, ‘Being a mediator’, ‘Being a partner’, and ‘Being a facilitator of development’ which formed the basis of the main category ‘Tailoring healthcare, and social services to safeguard the patient’s best.’ The findings showed that RNCMs strive to investigate, identify, and assess older persons’ needs for coordinated care. They worked closely with patients and their relatives to engage them in informed decision-making and to implement those decisions in a personalized agreement that served as the foundation for the care and social services provided. Additionally, the RNCMs acted as facilitators of the development of the PCCHCM, improving collaboration with other healthcare professionals and enhancing the possibility of securing the best care for the patient.ConclusionsThe results of this study demonstrated that RNCMs tailor healthcare and social services to provide care in various situations, adhering to person-centered care principles and continuity of care. The findings underline the importance of implementing integrated care models that consider the unique characteristics of each care context and adapt different case managers’ roles based on the patient’s individual needs as well as on the specific needs of the local setting. More research is needed from the patients’ and their relatives’ perspectives to deepen the understanding of the PCCHCM concerning its ability to provide involvement, security, and coordination of care.

Towards a Person-Centered Care Model Among Community Mental Health Services

Mental illness is widespread among adults and remains the foremost cause of years lived with disability. Despite its importance, there is a scarcity of research on person-centered care (PCC) from the viewpoints of mental health service users, particularly within clinical community mental health services. This study sought to investigate the potential for enhancing PCC through the lived experiences of individuals with mental health conditions who use local community mental health clinics (CMHC) in Malta. The goal was to obtain a thorough understanding of the current landscape, evaluate its strengths and weaknesses, and identify strategies for evolving the system towards a more PCC-focused model. A qualitative research design was utilized, following the principles of Interpretative Phenomenological Analysis (IPA) as described by Smith et al. (2009). Ten participants from Malta, including six women, who frequently visit CMHCs, were recruited through intermediaries. Each participant took part in a one-hour semi-structured interview, conducted at a mutually convenient time and location. These sessions were audio-recorded and transcribed verbatim for subsequent analysis. The analysis identified three main themes: Quality care, emotional support, and partnership and collaborative care, each comprising various sub-themes. The study illuminated both the strengths and shortcomings of the existing system and their implications for a PCC-oriented healthcare approach. While our findings reaffirm research on the critical role of empathy in care and other relevant factors, results also indicate that cultural factors in Malta, such as strong family ties, significantly influence the delivery of person-centered care (PCC), which may be relevant for other small communities. Furthermore, the research offers healthcare professionals (HCPs) a chance for ongoing professional development in accordance with the latest PCC principles.

Person Centred Care in Neurological Rehabilitation: A Case Study and Critical Reflection

Healthcare systems and organizations consider maintaining and improving the quality of their service provisions whilst also being mindful of strategies to mitigate identified gaps in their clinical services. One such approach that has found favour among healthcare teams and institutions is that of person centered care. Person centered care places emphasis on situating the individual at the core of the decision-making process, identifying, and illuminating what is of greatest importance to the concerned person. The approach fosters a belief in equal and collaborative goal setting between the person and their healthcare team, respecting the individual’s needs and their preferences as people. One area where this approach can be adopted is that of neurological rehabilitation. The ethos of mutual respect and partnership between the individual and the multidisciplinary team can guide and inform the process of rehabilitation. This paper aims to deliver a critical appraisal of the application of the principles of person centered care in neurological rehabilitation. This will be referenced to a clinical scenario involving a young person with a stroke. The case will link the theory of person centered care discussing the models and frameworks realised in the clinical story. This will lead to a discussion and conclusion on the value of person centered care for people, professionals, teams, and organizations.

Enhancing audiology students’ understanding of person-centered care: insights from an multi-national virtual student conference

Objective This project sought to investigate the impact of a multi-national peer learning initiative in facilitating a student-led conference on person-centred care (PCC). The primary objective was to assess students’ comprehension of PCC elements before and after engaging in the opportunity, with a concurrent evaluation of the efficacy of the opportunity. Design A mixed-methods study protocol was followed. Following the conference, participants completed a four-part survey including (a) demographics, (b) retrospective pre-post Likert scale, (c) Likert rating of conference experience and (d) five open-ended questions. Study sample One hundred and four participants (92.4% female) with a mean age of 21 years (0.07 SD) participated in the study. Results A significant difference in awareness pre-post conference was demonstrated across all topics (WSR, p < 0.001) with participants satisfied with the conference. Qualitative analysis revealed three main themes: (a) application of PCC; (b) perspectives of PCC; and () barriers to PCC; with nine sub-themes. Conclusion The conference was beneficial in enhancing students’ awareness of topics and principles of PCC. Innovative pedagogical approaches should be considered in order to enhance healthcare education allowing future clinicians to better meet the dynamic needs of their clients.

12 Tips for Centering Patient Voices through "Lived Experience Panels" in Preclinical Undergraduate Medical Education.

Background: Integrating patient narratives into medical education enhances understanding of person-centered care, empathy, and the human experience of illness. This paper explores the implementation of lived experience panels (LEPs) in preclinical medical education. Aims &amp; Description: Twelve strategies for effective LEP integration are presented, emphasizing thoughtful curation of panelists, timing considerations, vulnerability cultivation, and empowerment of marginalized voices. The paper outlines leveraging virtual platforms, skillful facilitation, student and patient preparation, post-session support, and debriefing mechanisms. Experiences from the University of Texas Branch at Galveston are showcased. Conclusion: The incorporation of LEPs into medical education holds immense potential for benefiting both learners and patients. Ensuring intentional and sensitive inclusion of these panels is paramount for the development of impactful curricula. By incorporating patient voices into medical education, we can nurture empathy, reinforce person-centered care principles, and cultivate authentic connections among learners, ultimately facilitating a transformative shift in the dynamics of the physician-patient relationship.

Analysis on the management strategy of happiness education based on human-oriented care

This study aims to explore happiness education management strategies for engineering students based on person-centered care. The research adopts a mixed-methods approach, combining quantitative and qualitative research. In the quantitative phase, a sample of 300 engineering students is recruited through a questionnaire survey. In the qualitative phase, 15 engineering students participate in semi-structured interviews, and 2 focus groups are conducted. The research results indicate differences among engineering students in dimensions of happiness, such as positive emotions, self-satisfaction, social support, and academic satisfaction. The application of person-centered care in happiness education has a positive impact on students’ learning motivation, emotional identity, and self-satisfaction. Additionally, current happiness education management strategies have achieved certain results in emotional management and social support but still have room for improvement in personalized support and care. Strategies based on person-centered care show significant advantages in multiple dimensions, comprehensively meeting the emotional and social needs of engineering students and enhancing their happiness levels. The findings of this study highlight the crucial role of person-centered care in happiness education for engineering students. It is recommended to strengthen the integration of person-centered care principles, provide diversified emotional management support, enhance the construction of social support networks, develop personalized happiness education plans, and continually assess and improve the effectiveness of strategies. These recommendations will contribute to optimizing happiness education management for engineering students, promoting their comprehensive development and growth.

Acute-Onset Acquired Stuttering Secondary to Concussion: A Case Report

Purpose: Acquired stuttering in young adults can present diagnostic and treatment challenges. This single case report documents the diagnosis of acquired, postconcussive, acute-onset stuttering in an 18-year-old man, describes key elements of a person-centered treatment program conducted via a telerehabilitation platform, and reports documented changes in speech production following intervention. Method: Person-centered care principles, disfluency education, strategies for managing stuttering episodes, and a home program were treatment components. Using the Overall Assessment of the Speaker's Experience of Stuttering (OASES) and speech sample analyses, documentation of initial status and changes over time came from initial, 3-month, 6-month, and follow-up evaluations. Results: Initial OASES scores were consistent with moderate–severe impact for General Information, moderate impact to Daily Communication, and mild–moderate impact with respect to Speaker's Reactions, Quality of Life, and Overall Assessment. The initial speech sample analysis revealed severely disrupted speech production with disfluencies occurring on 60.47% of syllables. In contrast, the 6-month assessment revealed mild or mild–moderate OASES impact scores and disfluencies on 1.78% of syllables. Performance during a follow-up evaluation held 3 months following treatment termination confirmed maintenance of fluent speech production both when reading and engaging in conversation. Conclusion: Clear differentiation between neurogenic and functional contributions to acute-onset, acquired stuttering is not always possible. In some cases, a combination of precipitating factors may be evident. Regardless, presenting traditional fluency management strategies within a framework of person-centered care can be an effective treatment approach. Supplemental Material: https://doi.org/10.23641/asha.25463968

P093 Innovating in IBD care: what do patients and informal caregivers value? Preliminary results of a narrative inquiry

Abstract Background Given the increasing incidence, evolving treatment goals, and the need for tight and holistic monitoring, transformation in delivery of Inflammatory Bowel Disease (IBD) care is warranted. To innovate successfully, it is crucial to consider the values of healthcare professionals (HCP) and healthcare services, as well as the patient’s and informal caregiver’s perspective. This study aims to explore what patients with IBD and their informal caregivers value in Dutch IBD care. Methods In total, approximately 16 patients and 8 informal caregivers from an academic and a general hospital will be included. Respondents are recruited purposefully. Data collection will take place until data saturation is reached. The interviews are focused on real-life experiences and stories of respondents with regard to IBD. Interviews are conducted face-to-face or digitally, audio recorded and transcribed verbatim. Independent coding was executed by three researchers. A deductive thematic analysis approach was used, guided by the Picker Principles of Person Centred Care. Results Semi-structured narrative interviews were conducted with 8 IBD patients and 4 informal caregivers, i.e. family members, between June-September 2023. All Picker principles came across in the narratives. Respondents said that it is important to receive an effective treatment, minimizing intestinal symptoms and to function as good as possible with IBD. Involving patients in their treatment plan and paying attention to non-medical aspects, e.g. impact on work and social relationships, was relevant to respondents. Patients and caregivers valued easy and accessible communication with their HCP, the feeling to be heard, and immediate action of the HCP when required. A trustful relationship, fostered through e.g. regular face-to-face contact, was highlighted as important. Some respondents appreciated the use of eHealth tools, as these facilitate remote care if desired. Moreover, providing informal caregivers with information about the disease, treatment and impact on daily life was suggested as beneficial in supporting patients with IBD. Conclusion IBD patients and their informal caregivers value shared decision making, fast access to reliable healthcare advice, immediate action when needed, the feeling to be heard and a trustful relationship with their HCP when receiving IBD care in the Netherlands. These values and insight in the (shared)-values of all relevant stakeholders within the Dutch context will facilitate the development of valuable innovation and successful implementation. The perspectives of other stakeholders, such as HCPs, policymakers, health insurers, pharmaceutical companies, and eHealth providers, will be explored in an extensive qualitative study.

The person first: reflections about reminiscence, decision and person-centered attention to reduce the psychological impact of losses in Residential Care Facilities (RCF ́s)

Background:Although the losses associated with aging activate additional psychological resilience resources, dependency settings, which often require admission to Residential Care Facilities (RCF's), need adequate care so that the person can maintain his/her dignity and quality of life. The activation of mechanisms for regulating losses and the preservation of the identity and autonomy of the person respecting his/her decision-making capacity are central for the preservation of the well-being of people with dependence. Portuguese RCF's are mainly based on care models that are opposed to the models of attention centered on the person, which value the person's potential and decision-making capacity. The COVID-19 pandemic has tested RCF's, highlighting their weaknesses and limitations.Objective:This study aimed to identify ways to improve the provision of care in RCF's during the pandemic.Method:This is a qualitative study, with data collection through an online questionnaire. Participants were invited to indicate strategies to improve the provision of care to elderly residents in RCF's. The study included 198 RCF ́s workers during the COVID-19 pandemic. Content analysis of the collected data was performed.Preliminary results on the ongoing study: The results indicate that the strategies that RCF´s workers consider most necessary are at the level of human resources, also highlighting the need for greater proximity, affection and attention to residents, the personalization of care and the valorization of the resident person and his/her opinions. These are considered by the participants as central strategies for the quality of care and satisfaction of RCF ́s workers.Conclusion:The needs identified are in line with the guiding principles of Person-Centered Care. The use of reminiscence as a strategy for valuing the person and his/her identity, as well as the promotion of self-determination, evaluating and allowing the person to make decisions may be central to meeting the needs identified at the level of care. The necessary transition from RCF's in Portugal to paradigms of centered care is thus reinforced by the results of this study.

Effectiveness of a person-centred eHealth intervention in reducing symptoms of burnout in patients with common mental disorders – secondary outcome analysis of a randomized controlled trial

BackgroundThe number of people with common mental disorders (CMDs), especially stress-related disorders, has increased in several countries, including Sweden, during the past decade. Patients seeking care for long-term stress report severe symptoms. Although person-centred care (PCC) has shown several benefits, studies evaluating the effects of a PCC eHealth intervention on patients with CMDs are scarce.ObjectiveThe aim of this study was to compare levels of self-reported symptoms of burnout between a control group receiving treatment as usual (TAU) and an intervention group receiving TAU with the addition of a person-centred eHealth intervention, in patients on sick leave for CMDs.MethodsThis study reports analysis of a secondary outcome measure from a randomized controlled trial. Patients (n = 209) on sick leave for CMDs were recruited from nine primary health care centres and allocated to either a control group (n = 107) or an intervention group (n = 102). The intervention consisted of phone support and an interactive digital platform built on PCC principles. Self-reported symptoms of burnout were assessed using the Shirom-Melamed Burnout Questionnaire (SMBQ) at baseline and at 3 and 6 months.ResultsOur findings showed changes in SMBQ scores over time in both the control and the intervention group. There was no significant difference in SMBQ scores between the groups; however, a difference in change over time between the groups was observed. The SMBQ scores decreased significantly more in the intervention group than in the controls between 0 and 3 months and between 0 and 6 months. No differences in change between the two groups were seen between the 3- and 6-month follow-ups.ConclusionThis person-centred eHealth intervention for patients on sick leave for CMDs showed a slight initial effect in reducing symptoms of burnout. Taking into account that both groups reported comparable SMBQ scores throughout the study period, the overall effect may be considered limited.Trial registration: The trial was registered in ClinicalTrials.gov (Identifier NCT03404583). Date of registration: 19/01/2018. https://clinicaltrials.gov/ct2/show/NCT03404583.

Becoming partners in rehabilitation with patients in intensive care: physiotherapists’ perspectives

Purpose Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting. Methods A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software. Results Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person’s clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care. Conclusions Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.

A Visual Analog Scale for Self-Reported Quality of Life: A Comparison of VAS and QoL-AD in Older Adults.

People with dementia (PWD) are one of the fastest-growing clinical populations for speech-language pathologists. Self-reported quality of life (QoL) assessments are critical patient-reported outcome measures that align with person-centered care principles. However, proxy-reporting is most often used due to assumptions that PWD cannot provide reliable self-report. Visual analog scales (VASs) have been successfully used with people with expressive and cognitive deficits to measure subjective constructs such as QoL, mood, and pain. The purpose of this project is to evaluate the feasibility and reliability of a VAS QoL assessment tool. Twenty older adults free of cognitive impairment were assessed using the quality of life in Alzheimer's disease (QoL-AD) and the QoL-AD in combination with a VAS (VAS QoL-AD). The construct validity, internal consistency, and test-retest reliability of the VAS QoL-AD were assessed by performing both assessments twice, 4 weeks apart. Significant correlations between the overall VAS QoL-AD and the QoL-AD scale ratings, between most of the QoL-AD and VAS QoL-AD subtests, and between the first and second assessment scores were observed. Results indicated strong construct validity, internal consistency, and test-retest reliability of the VAS QoL-AD in people without dementia. These results warrant further research into the development of a dementia-specific, self-reported VAS QoL scale for PWD.

The Impact of Collaborative Documentation on Person-Centered Care: Textual Analysis of Clinical Notes.

Collaborative documentation (CD) is a behavioral health practice involving shared writing of clinic visit notes by providers and consumers. Despite widespread dissemination of CD, research on its effectiveness or impact on person-centered care (PCC) has been limited. Principles of PCC planning, a recovery-based approach to service planning that operationalizes PCC, can inform the measurement of person-centeredness within clinical documentation. This study aims to use the clinical informatics approach of natural language processing (NLP) to examine the impact of CD on person-centeredness in clinic visit notes. Using a dictionary-based approach, this study conducts a textual analysis of clinic notes from a community mental health center before and after staff were trained in CD. This study used visit notes (n=1981) from 10 providers in a community mental health center 6 months before and after training in CD. LIWC-22 was used to assess all notes using the Linguistic Inquiry and Word Count (LIWC) dictionary, which categorizes over 5000 linguistic and psychological words. Twelve LIWC categories were selected and mapped onto PCC planning principles through the consensus of 3 domain experts. The LIWC-22 contextualizer was used to extract sentence fragments from notes corresponding to LIWC categories. Then, fixed-effects modeling was used to identify differences in notes before and after CD training while accounting for nesting within the provider. Sentence fragments identified by the contextualizing process illustrated how visit notes demonstrated PCC. The fixed effects analysis found a significant positive shift toward person-centeredness; this was observed in 6 of the selected LIWC categories post CD. Specifically, there was a notable increase in words associated with achievement (β=.774, P<.001), power (β=.831, P<.001), money (β=.204, P<.001), physical health (β=.427, P=.03), while leisure words decreased (β=-.166, P=.002). By using a dictionary-based approach, the study identified how CD might influence the integration of PCC principles within clinical notes. Although the results were mixed, the findings highlight the potential effectiveness of CD in enhancing person-centeredness in clinic notes. By leveraging NLP techniques, this research illuminated the value of narrative clinical notes in assessing the quality of care in behavioral health contexts. These findings underscore the promise of NLP for quality assurance in health care settings and emphasize the need for refining algorithms to more accurately measure PCC.

Poster (Clinical/Best Practice Implementation) ID 2004605

Background/Objectives The Centre for Family Medicine Mobility Clinic strives to provide high quality primary care to persons living with spinal cord injury or other health conditions that affect mobility. The Mobility Clinic Resource Abilities Council (MC RAC) was established to serve in an advisory capacity, making recommendations on matters that impact the experience of patients with physical disabilities and their support persons at the Mobility Clinic. Objectives MC RAC provides feedback on, and ideas for initiatives and programs that support and enhance the model of person-centred care. It also advances collaborative patient engagement and person-centred care principles and practices within primary care for persons with physical disabilities Methods/Overview Members include individuals with lived experience with physical disability, their support persons, and Mobility Clinic staff. The council was established August 2022 and meets virtually once per month for approximately 90 minutes. Results MC RAC has successfully met nine times and has provided feedback on the following topics: Breast &amp; Cervical Cancer screening Initiative for People with Physical Disabilities, Mobility Clinic website development, building pathways for advocacy with the KW4 OHT, Circulus Network webinar topics, Mobility Clinic organization and clinical flow. Feedback to be implemented into Mobility Clinic activities. Conclusions Patient and support persons involvement in decision-making processes improve care experiences and contribute to better health outcomes for patients. We will continue to work and develop our patient advisory council to better support the Mobility Clinic’s patients and their support persons.

From Detractors to Promoters: A comparative analysis of patient experience drivers across Net Promoter Score subcategories.

The utilization of patient experience surveying by health care institutions has become increasingly prevalent, yet its effectiveness in promoting quality improvement remains uncertain. To enhance the utility of patient feedback, the examination of free-text comments may provide valuable insights to guide patient experience strategy. This study aims to explore the utility of free-text comments and identify key differences for patient experience drivers between Net Promoter Score (NPS) subcategories of Detractors, Passives, and Promoters. Evaluation and classification of comments was conducted using the eight Picker Principles of Person Centred Care, with descriptive analysis of patient comments performed on the NPS data. Analysis of patient NPS comments can be classified into three key drivers: "feeling well-treated" (for Detractors), "feeling comfortable" (for Passives), and "feeling valued" (for Promoters). Specifically, Detractor comments provided the most comprehensive and detailed feedback to guide patient experience improvement activities. This study highlights differences between NPS subcategories, particularly regarding aspects of safety, comfort, and feeling valued. Comments from Detractor respondents may be especially useful for guiding quality improvements due to increased specificity and insights. These results also emphasize the essential nature of empathy and compassionate interactions between patients and clinicians to achieve the highest level of patient satisfaction and experience.

Partnering with consumers to co-design a person-centred coding framework for qualitative patient experience data

BackgroundPatient Reported Experience Measures (PREMs) provide health organisations insight into how ‘person-centric’ care is. Qualitative data in PREMs surveys provide essential context about experience but are challenging to analyse at an organisational level. ObjectiveTo co-design a person-centred coding framework to assist in the analysis of qualitative PREMs data. Patient involvementConsumer representatives were involved in problem identification, co-design, coding of raw data (testing), evaluation and manuscript authorship. MethodologyCo-design principles guided production of a deductive coding framework with Picker Principles of Person-Centred Care as a conceptual framework. The framework was co-designed over 4 stages, with cross-professional stakeholders (including two consumer representatives): 1) assessment of current state and understanding priorities; 2) adapting Picker Principles of Person-Centred Care as a coding framework; 3) testing and evaluation of a coding template over two quality improvement (QI) cycles against measures of inter-coder reliability and perceived usefulness; 4) endorsement and planning for implementation. ResultsThe Picker Principles were a suitable coding framework for inpatient PREMs data, and a coding template in an electronic spreadsheet met end-user needs. Results of the first QI cycle indicated a need for ‘less academic’ domain names and definitions, which were reviewed and updated to a first-person perspective in partnership with a consumer representative. Inter-coder reliability measures and qualitative feedback improved after cycle two testing and evaluation. DiscussionThis single site study produced a feasible solution to apply person-centred principles to analyse PREMs data and requires testing in different settings. Cross-disciplinary partnerships enabled the development of a reliable and acceptable deductive coding framework that was usable for people without prior experience in qualitative data analysis. Practical valueOur solution offers an example for health services to harness the value of qualitative PREMs data and partner with consumers to take person-centric action to improve the safety, equity, and experience of healthcare.

Autonomy-supportive environments for people with dementia: an evidence-based review

Abstract Objective: As one of the core principles of person-centered care, supporting the autonomy of residents with dementia has received increasing attention worldwide. Supportive physical environments play an important role in promoting autonomy in the everyday life of residents in care facilities. However, there is no universal definition for autonomy in everyday life nor focused research on autonomy-supportive environments. Thus, this study aims to systematically review the existing evidence of autonomy-supportive design features based on a synthesized concept analysis of autonomy in everyday life. Methods: A synthesized concept analysis on autonomy was conducted based on related definitions of autonomy in design guidelines and environmental assessment tools of elderly care facilities. Using keywords from the concept analysis, multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, and Dementia Design Info were used to carry out a systematic review of autonomy-supportive environmental design features for people with dementia. Additional guidelines and standards were manually searched. The design features supported by empirical studies and studies based on experts’ experience were extracted from the literature. The evidence intensity of each feature was assessed according to the quality and quantity of related studies. Results: Four domains of autonomy, freedom, independence, control, and choice emerged based on the concept analysis. Seventy-eight autonomy-supportive design features were extracted from the literature. Features are summarized into 8 categories: building layout, circulation space, living room, dining space, bathroom, bedroom, outdoor space, and details. Of design features, 60% in the category of building layout have been cross-validated by empirical studies, whereas only 25% of the overall design features have. Conclusions: The results of this review show that numerous design features of the physical environment can support the autonomy of people with dementia in the 4 domains. Features of building layout are well researched and the evidence intensity for the rest of design features still needs to be improved through future empirical studies.

Truth that Matters

Truth that Matters

People who use drugs in hospital settings: 'Moving towards a person-centred harm reduction model'.

People who use drugs often continue to use drugs while in hospital. However, health-care systems often expect abstinence from drugs as a condition of engagement in various services. This commentary piece proposes that this approach is inconsistent with the principles of person-centred care. A harm reduction-based approach in conjunction with collaboration of people who use drugs is proposed as a model for providing person-centred care to people who use drugs during hospital-based treatment.