Provision Of Patient-centered Care Research Articles

Dentists’ perceptions of a practical model of patient-centred care: providing information and choice in a dental consultation

ABSTRACTAdopting a patient-centred approach when engaging with patients has been linked to positive outcomes in medicine. However, in the field of dentistry, patient-centred care (PCC) has been understudied. The aim of this study was to explore dentists’ opinions about the usefulness of a theoretical model of PCC and its applicability to a dental setting. Twenty semi-structured interviews were conducted with dentists working at a major university hospital in south London. The interviews were audiotaped and analysed using thematic analysis. The analysis showed that dentists found the PCC model to be useful for practical application but mostly for ‘other’ dentists. They viewed the lowest and highest levels of PCC that the model advocates as ‘out-dated’ and ‘ideal’, respectively. Dentists felt that giving patients full choice and control over their treatment was not applicable to everyday clinical practice. They expressed that a tool developed on the basis of this hierarchy of PCC could be useful for self-assessment purposes, although with some reservations. In conclusion, dentists seemed to embrace the practice of PCC and felt that their provision of PCC was at an acceptable standard. They believed that a moderate level of information and choice was most suitable for patients.

Learning What is Important: A Quality Improvement Initiative to Enhance Patient-Centred Care in Home Care

Aim: A quality improvement initiative was undertaken to increase the utilization of a new tool designed to facilitate the provision of patient-centred care in the homecare setting. Methods: The tool, entitled Life Through My Eyes (LTME), is completed voluntarily by the patient or a family member. In order to personalize the patient’s care, it captures information about what is important to the patient and ways to make the patient feel comfortable. Patients and families played an integral role in the Plan, Do, Study, Act cycle used to introduce the tool into practice. Results: Patients and family members (n = 19) and personnel (n = 7) offered feedback that directed revisions to the tool’s format, and additional strategies were implemented to increase personnel’s familiarity with the tool. Conclusion: Improvements in the format and in the implementation process for the LTME tool were identified through a QI initiative, and the revised tool has now been distributed broadly.

Empathy and the Development of Affective Skills

Empathy, the most important human attribute that matters in every aspect of life, is essential in health care. Provision of patient-centered care requires empathic health care practitioners. The correlation between empathy of health care providers and improved patient adherence, satisfaction, and treatment outcomes is well-established. Scholarly evidence shows positive correlations between empathy and affective domains and confirms that soft skills are grounded in empathy. Empathic students have stronger affective skills and are capable to acquire, develop, reinforce, and display strong affective behaviors, abilities, and attitudes. As an innate quality, empathy is malleable. The level of empathy can be influenced by educational interventions inculcated into students during the entire curriculum, including both didactic and experiential training. The effectiveness of educational methods may be strengthened by activities that help students enhance empathy and achieve required affective skills. Empathy and the empathy-based affective skills essential in patient-centered care should be routinely and deliberately taught, modelled, and assessed across the continuum of health care curricula.

Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors.

The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion-adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.

The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient’s perspective

ObjectiveTo investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals’ provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ). MethodsA sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested. ResultsThe PPIQ confirmed the original four-factor structure (effective communication, interest in the patient’s agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients’ social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients’ educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient. ConclusionThe PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals. Practice implicationsThe PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients’ reported experience is an important dimension of the clinician’s performance.

The provision of patient-centred care: A qualitative analysis of community pharmacists’ views after consultation skills training

To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners.We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies.Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners’ performance.Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners.Several patient feedback questionnaires are available, showing potential for supporting practitioners’ development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations.

Mindful Dentist

Dental anxiety challenges patients and providers alike, creating barriers to care, increasing pain perception, and increasing the time and effort required to complete treatment. While patient-centered dentistry invites us to care for the person attached to the teeth, many dentists feel ill-equipped to handle the many emotions that arise during dental treatment. Mindfulness and the practices that cultivate it are invaluable to the provision of patient-centered care in four respects: 1) it provides balance to the dental professional during stressful times, 2) it cultivates the qualities of a patient-centered health care provider 3) it guides actions necessary to meet a patient’s needs, 4) it provides techniques that patients can themselves use to find balance during stressful times. All of these fruits of mindfulness practices are demonstrated in three true vignettes of fearful patients who were treated by the author. Video footage of the three stories is also provided.

Promoting Patient-Centered Care During Residency Training: an Inpatient Tale of Two Programs

Teaching residents to provide patient-centered care (PCC) is a challenge within traditional residency programs. We describe strategies developed to adapt a PCC curriculum from an existing program to a new one, highlighting components that were duplicated as well as those that were adapted to local needs. The authors compared their PCC curricula against known barriers to PCC teaching, identified strategies as shared or tailored in each domain, and described outcomes. Sixteen shared curricular strategies were identified. One hundred percent of pediatric residents (n = 20) “agreed or strongly agreed” that the newly adopted PCC strategies promote an understanding of patient-centered care. Success related to shared and tailored strategies may inform how PCC training models in other specialties may be developed.

Using Colaizzi's method of data analysis to explore the experiences of nurse academics teaching on satellite campuses.

Phenomenology is a useful methodological approach in qualitative nursing research. It enables researchers to put aside their perceptions of a phenomenon and give meaning to a participant's experiences. Exploring the experiences of others enables previously unavailable insights to be discovered. To delineate the implementation of Colaizzi's ( 1978 ) method of data analysis in descriptive phenomenological nursing research. The use of Colaizzi's method of data analysis enabled new knowledge to be revealed and provided insights into the experiences of nurse academics teaching on satellite campuses. Local adaptation of the nursing curriculum and additional unnoticed responsibilities had not been identified previously and warrant further research. Colaizzi's ( 1978 ) method of data analysis is rigorous and robust, and therefore a qualitative method that ensures the credibility and reliability of its results. It allows researchers to reveal emergent themes and their interwoven relationships. Researchers using a descriptive phenomenological approach should consider using this method as a clear and logical process through which the fundamental structure of an experience can be explored. Colaizzi's phenomenological methodology can be used reliably to understand people's experiences. This may prove beneficial in the development of therapeutic policy and the provision of patient-centred care.

Incorporating supportive care into the hemodialysis unit.

Advance care planning is underutilized in patients with dialysis-dependent kidney failure and the provision of high intensity rather than supportive care is a standard practice in most hemodialysis units wherever challenges to incorporating palliative or supportive care into unit processes remain formidable. The practice of advance care planning empowers patients, families and physicians and drives decisions about future treatment that align with patients' values, wishes and changing clinical circumstances. Barriers to incorporating supportive care exist; however, advance care planning optimizes the chance for future care that is smooth, compassionate, timely and supportive. Care that is palliative in nature may be desired by dialysis patients suffering from escalating comorbid illness and ongoing clinical decline. Advance care planning addresses wishes for future treatment and serves as a prerequisite to the provision of patient-centered care. Nephrologists are uniquely poised to promote a culture that incorporates shared decision-making and support for palliative treatment into dialysis unit care.

Nurse Perceptions of Artists as Collaborators in Interprofessional Care Teams.

Increased attention is being given to interprofessional collaboration in healthcare, which has been shown to improve patient satisfaction, patient safety, healthcare processes, and health outcomes. As the arts and artists are being more widely incorporated into healthcare settings throughout the world, professional artists are contributing to interprofessional care teams. A secondary directed content analysis of interviews with 31 nurses on a medical-surgical care unit investigated the roles and impacts of professional artists on the interprofessional care team. The investigation utilized established domains of interprofessional care, including values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork, and created the domain of quality of care. Findings suggest that artists are valued by nurses as members of the interprofessional care team, that they enhance the provision of patient-centered care, and that they improve quality of care by providing holistic dimensions of caring, including cognitive and social engagement, and meaningful interaction. The presence of artists on interprofessional teams provides a cost-effective and welcome resource for clinical staff and builds a culture in which creativity and interdisciplinary collaboration are more highly valued and activated.

Patient or Physician Centered Care?: Structural Implications for Clinical Interactions and the Overlooked Patient

Patient-centered care is widely supported by physicians, but this wide-spread support potentially obscures the social patterning of clinical interactions. We know that patients often want religious/spiritual conversations in the context of medical care but the provision is infrequent. As there is regional variance in religiosity, a gap in the literature exists regarding whether patient populations’ religiosity is connected to physicians’ self-reported religious/spiritual interactions. Using a national sample of U.S. physicians linked to county-level measures, the author test whether both physicians’ background and patient population characteristics are related to religious/spiritual interactions. Specifically, do physicians in more religious locations report more frequent religious interactions and is this dependent on whether the physician is also religious? Or does the religiosity of patient populations fail to explain variance in the frequency of inclusion? Logistic regressions with spatial lag terms highlight the importance of physicians’ background for inclusion of religiosity/spirituality. County-level variance of religious concentration is largely unrelated to the inclusion of religiosity/spirituality. The provision of patient-centered care is complicated. The inclusion of something patient-specific, such as religious/spiritual content, may not depend on the characteristics of the patient population, but those of the physician they see.

Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life.

In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.

Creating a Sacred Space in the Intensive Care Unit at the End of Life.

Improving care at the end of life is a health priority. At least one-third of deaths in the United States occur in the hospital; nearly half of the Americans who die in the hospital will have spent time in the intensive care unit during the last 3 days of life. Critically ill patients and their families identify significant unmet spiritual, environmental, and communication needs. Although the Society of Critical Care Medicine recommends that the spiritual needs of critically ill patients be addressed by the health care team and be incorporated in patients' plans of care, spiritual concerns are infrequently addressed during goals-of-care discussions. The American Association of Critical-Care Nurses' Synergy Model recognizes the central importance of spirituality to the provision of patient-centered care. Furthermore, the model highlights the value of the relationship between the patient and the nurse to a healing environment. The privileged connection between patients and nurses, foundational to the creation of a healing environment, may be understood as a sacred space. Critical care nurses are uniquely positioned to improve end-of-life care by focusing on the spiritual, environmental, and communication needs of their patients through the creation of a third space in the intensive care unit, a sacred space.

Patients’ fear of physicians and perceptions of physicians’ cultural competence in healthcare

ABSTRACTBackground: Fear of physicians is associated with a variety of negative relationship and clinical outcomes. Culturally competent communication has been suggested as a way for physicians to reduce patient fear. Previous research has not, however, assessed whether patients’ perceptions of physicians’ cultural competence are associated with the level of felt fear. This study assessed associations between patients’ fear of physicians and their perceptions of physicians’ cultural competence in healthcare interactions.Method: In this cross-sectional study, a purposive sample of 306 patients were recruited from the patient base of a local clinic system with three locations, one rural, one suburban, and one urban in Appalachian Ohio. Using validated paper-and-pencil questionnaires, we assessed patients’ perceptions of physicians’ cultural competence in four domains (macro cultural issues, proxemics/chronemics, language issues, and patient-centeredness) as well as fear of physicians.Results: Fear of physicians was associated with perceptions that physicians’ accommodated cultural differences related to issues of personal space and time and with perceptions of physicians’ provision of patient-centered care. Other domains of intercultural competence indicated negative association, but were not significant.Conclusions: The findings of this study provide evidence that some forms of physician accommodation of cultural difference are associated with reduced fear of physicians. These findings have implications for promoting physicians' cultural competence in healthcare interactions. These implications, with a focus on patient-physician communication are discussed.

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

ABSTRACTBackground: Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice.Objective: To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites.Design: Survey and nominal group data from post-graduate trainees at three residency programs.Results: A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p < 0.01 for 4/11 tasks), planning and managing care (p < 0.01 for 3/4 tasks), providing self-care and community support (p < 0.01 for 3/5 tasks), and identifying and managing patient populations (p < 0.01 for 1/6 tasks), but were not more likely to report tracking and coordinating care or measuring and improving performance. Residents at PCMH sites were more likely to report working with medical assistants (p < 0.01), but not other healthcare professionals. Qualitative data showed staff teamwork and continuity of care as facilitators of patient-centered care, and technological problems and office inefficiencies as barriers to care.Conclusions: Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care.Abbreviations: EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home

Maternal satisfaction regarding perinatal care and influencing factors in tertiary hospitals of western, Nepal

Satisfaction has been widely recognized as an important indicator to evaluate health care quality and to provide patient centered care. The study was carried out to assess satisfaction level from a hospital based perinatal care. A descriptive cross sectional study was carried out among 428 postnatal women in two tertiary hospitals of western Nepal via structured interview schedule. Maternal satisfaction was measured by 25 item scale. Overall 45.1% of mothers were satisfied with the perinatal care. The level of satisfaction in public hospital (mean 3.44±0.65 out of 5) was greater as compared to private hospital (mean 3.27±0.59 out of 5). The satisfaction score was lower in the physical environment (mean 3.01±0.87 out of 5) and highest in privacy maintained (mean 4.37±0.92 out of 5). Determinants of satisfaction were type of hospital, religion, education, parity, number of living children, mode of delivery, gestational age at birth, maternal condition after delivery, newborn health condition, and duration of stay at the hospital and the gender of the provider (p

Athletes' Perception of Athletic Trainer Empathy: How Important Is It?

Health care practitioners face increasing expectations to provide patient-centered care. Communication skills, specifically empathy, are critical in the provision of patient-centered care. Past work correlates empathy with improved patient satisfaction, compliance, and treatment outcomes. In particular, a predictive relationship exists between clients' ratings of their clinician's empathy and treatment outcomes. There is a dearth of studies examining empathy using qualitative methodology and factors of empathy in athletic training. To gain an understanding of athletes' perceptions of empathy in the patient-clinician relationship. Qualitative interviews were completed using grounded-theory techniques. A quiet office. A typical, purposeful sample of 15 college-ageDivision I student-athletes (8 female,7 male; 19.3 ± 1.2y) from a variety of sports (football, wrestling, volleyball, baseball, etc) participated. Researchers utilized an interview protocol designed to understand the factors of empathy related to athletic training. The interview protocol established a concept of empathy to help facilitate discussion of ideas. Data were transcribed, coded, and analyzed for themes and patterns using grounded-theory techniques. Trustworthiness of the data was ensured using an external auditor, member checks, and methods triangulation. Five themes described empathy: advocacy, communication, approachability, access, and competence. Advocacy was described as the athletic trainer (AT) representing the patient. Communication was the ability to listen reflectively; approachability emerged as the comfort and personal connection the patient felt with the AT. Access and technical competence were bridges required for the development of empathy. Providing patient-centered care facilitated by developing good patient-clinician relationships is critical in enabling the best treatment outcomes. ATs portray empathy through advocacy, communication, and approachability. Empathy improves the patient-clinician relationship and is critical for patient-centered care delivered by ATs.

Self-perceived provision of patient centered care by healthcare professionals: The role of emotional intelligence and general self-efficacy

ObjectiveThis study aimed to investigate whether healthcare professionals’ emotional intelligence (EI) is associated with self-perceived provision of patient-centered care (PCC), taking into account the potential mediating effect of general self-efficacy (GSE). MethodsA sample of 318 healthcare professionals, recruited in 2015 among four hospitals in Italy, completed the Provider-Patient Relationship Questionnaire, the Emotional Intelligence Scale, and the General Self-Efficacy scale. A structural equation model was tested with GSE mediating the relationship between EI and self-perceived provision of PCC. Groups of participants based on gender, profession, and work setting were also compared on the study variables. ResultsEI had direct effects on the self-perceived provision of PCC dimensions. GSE partially mediated only the relationship between EI and involving the patient in care. Healthcare professionals in rehabilitation units showed higher self-perceived provision of PCC than those in acute care or ambulatory services. ConclusionSelf-perceived provision of PCC seems to have the potential to be improved by EI and to be distinguishable from GSE. Practice implicationsSince EI can be developed, findings of this study have potential implications for improving PCC through continuing education interventions for healthcare professionals.

Evaluation of Qatari and Canadian Pharmacy Students Learning Together about Cultural Competency using Videoconference Educational Activities

Background: Pharmacists are under pressure to provide patient centered care within increasingly culturally diverse settings. Pharmacy schools play an important role in educating learners regarding culture and its impact on patient care.&#x0D; Objectives: The objectives of this study were to determine if a novel cultural competency learning activity, which involved students from two culturally and ethnically different pharmacy schools learning together using videoconference education activities, improved: (1) student knowledge and confidence pertaining to cultural competency concepts, (2) attitudes and perceptions towards being a culturally competent pharmacist, and (3) academic performance related to cultural competency case studies.&#x0D; Methods: Pharmacy students from Qatar University in Doha, Qatar (n=25) and the University of Saskatchewan in Saskatoon, Canada (n=85) participated in a cultural competency activity comprised of small group work on a patient case study, followed by tutorial discussions. Some Canadian students (n=31/85) worked collaboratively (via video conference) with the students from Qatar. The evaluation used a convergent mixed methods design comprised of: (1) a pre and post session survey measuring student knowledge and confidence; (2) pre and post session student self-reflections; and, (3) student academic performance on care plans and an observed structured clinical exam (OSCE).&#x0D; Results: The survey identified small but statistically significant (p&lt;0.05) improvements in knowledge and confidence with respect to 11 of the 12 questionnaire items in the students from Canada and 2 of the 12 items in the students from Qatar. The self-reflections found that 44.4% (n=36/81) of students who completed the pre and post reflective questions reported a change in knowledge and attitudes regarding cultural competency, but a reason for the change was not evident. Student grades on the cultural competency care plans and the OSCE were not different between the students who worked collaboratively across the two schools compared with those who did not.&#x0D; Conclusion: The cultural competency student activity showed small improvements in pharmacy student knowledge, attitudes and confidence, but did not affect academic performance. Future research in this area could utilize a greater diversity of methodological approaches, including a focus on student self-reflection and qualitative assessment, to better capture student competency.&#x0D; &#x0D; Type: Original Research