Person Centred Care August - October 2019

This bulletin covers person centred health care, and should be of interest to staff working in this area, within acute, community and social care sectors.

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This bulletin contains a selection of material gathered from a search of the evidence base, and is not intended to be comprehensive. Professional judgment should be exercised when appraising the material. The Library takes no responsibility for the wording, content and accuracy of the information supplied, which has been extracted in good faith from reputable sources. NHSGGC is not responsible for the content of external internet sites.

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Bolt, S., van der Steen, J., Schols, J., et al (2019) What do relatives value most in end-of-life care for people with dementia?  International Journal of Palliative Nursing 25(9).  It is important that healthcare professionals inform an dsupport relatives to help them make decisions about end of life care and preferneces.  Nursing homes should learn to offer the same standard of person-centred care as a home care setting, and ensure that relatives are still involved in the care of the person with dementia.

Braithwaite, J., Churruca, K., Wells, L., et al (2019)  Partnering with patients for change and improvement: an Australian perspective.  Patient Engagement pp 169-198.  Australia has had a long-standing involvement in engaging with consumers, enouraging their participation in a multiplicaity of ways, across policy, orgasniational, and service delivery levels.  The Consumers Health Forum of Australia is at the forefront in coordinating activities  and making progress.  Gains have not been made across the baord, and there is a lack of a coordinated, national approach in part because Austrlia has a federated health system.  Nevertheless, there are manu intitiatives under way, and research to support progress is increasingly compelling.  Barriers to participation include institutional, attitudinal, social, and professional constraints, but there is also evidence of increased momentum for further involving consumers in healthcare.

Da Costa, DL., Corlett, SA., Dodds, LJ. (2019) A narrative review on the consultation tools avaialble for pharmacists in the United Kingdom: do they facilitate person-centred care? International Journal of Pharmacy Practice.  Tools available to UK pharmacists are inadequate for fully supporting delivery of a person-centred consultation in practice.  Revision of existing tools or creation of more pharmacy specific tools will support UK pharmacists delivery of person-centred consultations in practice.

Dixon, J., Knapp, M.  Delivering advance care planning support at scale: a qualitative interview study in twelve international healthcare organisations.  Journal of Long Term Care: pp 127-142.  Globally, populations are ageing, with people increasingly likely to die with chronic progressive illness.  In this context, there is widespread interest in advance care planning (ACP), where people are supported to think about and express preferences concerning their future care. 

Dutzi, I., Schwenk, M., Kirchner, M., et al (2019) "What would you like to achieve?" Goal-setting in patients with dementia in geriatric rehabilitation.  BMC Geriatrics 19 Article Number 280.  Collaborative goal-setting was feasible, especially when supported by a structured approach and yielded a large spectrum of funtional but also psychological rehabilitation neesd from the patients perspective.  Patiented showed sustained  insight in their functional impairments, limited in a subgroup of patients with more advanced cognitive impairment.

Elwyn, G., Neolson , E., Hager, A., Price, A.  (2019) Coproduction: when users define quality.  BMJ Quality and Safety 10:1136.

Fitzgerald, JA., Curry, J., Meierink, AO, Cully, A. (2019) Putting the consumer in the driver's seat: a visual journey through the Australian health-care system as experienced by people living with dementia and their carers.  Australaisian Journal of Ageing 23 May 2019.  A better understanding of the current health-care pathway of dementia is essential for the design and delivery of future health-care services.  It is vital to include the consumer voice in future research and allocation of health-care resources.

Guastello, S., Jay, K.  (2019) Improving the patient experience through a comprehensive performance framework to evaluate excellence in person-centred care.  BMJ Open Quality 8(4).  The structured Certification framework can help organisations identify PCC improvement opportunities, guide their implementaiton efforts, and better understand the impact on paient and staff outcomes.  Tested in cultures around the world and across the care continuum, the framework has proven effective in converting PCC into a definable, measurable and attainable goal.  This paper outlines how the programme was designed, the measurable benefits derived by organisations and lessons learnt through the process.

Kalsi, D., Ward, J., Lee, R. (2019) Recognising the dying patient, when less could be more: a diagnostic framework for shared-decision making at the end of life.  Journal of Patient Experience 12 September 2019.  Basedon themes common to 4 key specialties (cardiology, vascular surgery, emergency general surgery, and intensive care), the authors developed a novel diagnostic framework to support shared palliative decision-making that can be summarised as follows: 1) is the acute pathology reversible? 2) What is the patient's physioogical reservice? 3) What is important to the patient?  Will they be fit enough for discharge for a reasonable length of time?

Larsson, H., Handanovic, D., Rosengaren, K.  (2019) Simplifying the care plan documentation procedure - An interview study with nurses at a medical ward at a university hospital in Sweden.  Journal of Hospital Admission 8 (4).  Working with care plans is an important part of a nurse's work.  Procedure, use of documentation and ensuring regular revision all influence the quality of care due to the simple and clear structure of documentation within the medical record.  To strengthen the patient's involvement in a mutual care plan, nurses play a key role in implementing PCC, which is a tool used to improve partnerships between patients and health professionals.

Lewis, RA., Benzies, KM., MacRae, CT., Tonelli, M. (2019)  An exploratory study of person-centred care in a large urban hemodialysis program in Canada using a qualitative case-study methodology.  Canadian Journal of Kidney Health and Disease 6:1-15.  Person-centered care (PCC) can benegit patients, clinical staff, and health care organisations, but has not yet been widely adopted into practice.  Hemodialysis is a unique care environment in which clinical staff can be involved with patients for a protracted periods of time each week and often over a number of years.  While kidney care is arguably more holistic than other chronic condition managment programs, most patients requiring hemodialysis do not recieve care that is optimally patient-centred.

Ludecke, D., Poppele, G., Klein, J, Kofahl, C. (2019) Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case-control study comparing a regular ward with a special care ward with dementia care concept.  BMJ Open 2019;9:e03043.  A special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia.  Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL nd quality of care for these patients.

Nathan, S., Fiore, LL., Saunders, S., et al.  My life, my story; teaching patient centered care competencies for older adults through life story work.  Gerontology & Geriatrics Education 9th September 2019.  The authors implemented "My Life, My Story" as an educational activity for enhancing patient-centred care (PCC) competencies across health professions trainees.  A mixed method survey evaluated the effectiveness of the activity on enhancing PCC competencies using open ended quesions and ratings on the Consultation and Relational Empathy (CARE) Measure adapted for this project.  The assignment most influenced trainees' ability to understand the patient as a "whole person" along with other PCC competencies such as showing empathy, really listening, building knowledge of values and goals, and building relationships.  In addition, trainees perceived the activity enhanced patient care and was a positive contrast to usual care.

Peart, A., Lewis, V., Barton, C., et al (2019) Providing person-centred care for people with multiple chronic conditions: protocol for a qualitative stidy incorporating client and staff perspectives.  BMJ Open 9(10).  Chronic conditions are associated with over one-third of potentially avoidable hospitalisations.  Integrated care programmes aim to help people wth chronic conditions to self-manage their health, thus avoiding hospital admissions.  While founded on principles of person-centred care, the experience of people with multiple chronic conditions in integraed care programmes are not widely known.  This study explores how person centred care is incorporated into an integrated care programme for people with multiple chronic conditions

Scerri, A., Innes, A., Scerri, C. (2019) Person-centred dementia care in acute hospital wards - the influence of staff knowledge and attitudes.  Geriatric Nursing available online 17 October.  Person-centred dementia care practice in acute hospital wards are suboptimal and not commonly measured.  Although previous research has indicated that the work environment of staff influences their perceptions of person-centredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person centered dementia care practices.  The findings of this study demonstrate that to enhance person-centred dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.

van Oppen, JD., Keillor,L, Mitchell, A., et al (2019) What older people want from emergency care: a systematic review.  Emergency Medicine Journal.  Published online 24th October.  Older people wished to have prompt waiting times, efficient care, clear communication and comfortable environments.  THey had additional and unique expectations for holistic care and support in decision making.  The ED provoked a sense of vulnerability  among older poel who were likely to have frailty.