Developing Person-Centeredness: A Continual Process

April 23, 2019
By , DC, DHSc

By Anna-Marie Schmidt, MM, DC, and Robert D. Vining, DC, DHSc

Person-centeredness: an approach to health care focused on the person, placing high importance on

being respectful and responsive to individual preferences, needs, and values.1

Why is Person-centeredness Important?

There are several reasons for continually developing person-centered qualities among providers. First, both the World Health Organization (WHO) and the Agency for Healthcare Research and Quality (AHRQ) include person (people)-centered care and the preferences of the individual in their definitions of quality care.2–4 Second, person-centered care is recommended by clinical guidelines as an evidence-based practice.5,6 Third, research suggests patients prefer person-centered healthcare practitioners. Preferred characteristics include: 7

  • Good communication skills fostering open, empathetic discussion and collaboration.
  • Ability to clearly present information regarding diagnosis, cause of pain and recommendations.
  • Personalized, supportive and holistic approaches to care, fostering validation of the individual.

Finally, some evidence suggests a person-centered approach may help decrease anxiety about symptoms,8,9 improve treatment adherence,10 and/or increase trust in clinicians.8,11 Failing to foster a person-centered approach can have negative implications. For example, some evidence suggests that when practitioner communication style and patient attitudes are incongruent, satisfaction with care suffers.12

Developing Person-centeredness Is a Transformational Process

The process of cultivating a more person-centered approach may not be the same for every individual. Stories from several of the highest-rated practitioners within a large healthcare system highlight how individual transformation can facilitate becoming more person-centered.13 Person-centeredness skills among these physicians did not come naturally, nor were they the result of a personality trait. Instead, developing these skills occurred through conscious self-reflection and commitment. This process transformed how these practitioners thought about patients and themselves, changing their outlook on their role as doctor.

Transformation often stemmed from personal experiences that helped practitioners see their decision making and practices in a new light. These experiences helped reveal many usual decision-making approaches, previously thought to be person-centered, were actually self-oriented.13 Beneficial side-effects noted by practitioners who moved toward a more person-centered approach included higher patient satisfaction, newfound energy and sense of professional purpose.

Strategies to Enhance Person-centeredness

Mead describes person (patient)-centered care as existing in multiple dimensions focusing largely on doctor-patient interactions.14 Mead’s dimensions may help identify areas on which practitioners can focus to enhance person-centeredness skills. Dimensions include:

  • Incorporating social and psychological factors into patient evaluation and management.
  • Acknowledging the experience of illness is unique to each patient.
  • Health care as a collaborative effort between doctor and patient.
  • Leveraging of the psychological effects stemming from doctor-patient interactions.
  • Self-awareness of doctor, recognizing how personal interactions and subjectivity can influence the therapeutic relationship.

Egnew offers seven skills that align with a person-centered approach.15 By consciously developing each skill within the clinical encounter, practitioners can move closer to a more person-centered ideal.

  1. “Focus on the patient.” Take a moment before the patient encounter to personally prepare your thoughts and focus on the individual with whom you are about to engage.
  2. “Establish a connection with the patient.” Consciously establish an interpersonal connection with the patient by developing rapport. An intellectual connection should also be made. This could be through assuring the patient you will address what is important to both of you and collaboratively setting goals for the encounter.
  3. “Assess the patient’s response to illness and suffering.” An interest in how the individual’s health is impacting their everyday lives both physically and emotionally should be explored.
  4. “Communicate to foster healing.” Communication should be authentic, non-judgmental and demonstrate sensitivity.
  5. “Use the power of touch.” A gentle touch to the area that hurts is a powerful tool. Consider starting with a warm handshake first.
  6. “Laugh a little.” When used discerningly, laughter can be a useful tool in establishing rapport and making individuals comfortable.
  7. “Show some empathy.” Verbally communicate empathy by acknowledging the patient’s experience or feelings, such as “That must be difficult” or “This is a real problem for you.”

What is person-centered to one patient or practitioner may not be considered so to another. The Patient Practitioner Orientation Scale (PPOS) is a 18-item questionnaire designed to help practitioners understand where both they and their patients have strong preferences.16 When completed by a practitioner, responses can help identify areas of improvement and aid in self-reflection to further develop person-centered attitudes.

Practically speaking, the PPOS may also be used to help practitioners understand individual patient preferences, such as being treated as a partner, to inform person-centered care.1,14,17  Higher scores suggest general preferences for more interaction, collaboration and partnership.16,18 The PPOS, along with scoring information, may be accessed here.

Person-centeredness requires each clinical encounter to be unique. It involves setting aside universal decision-making and care in favor of personalized approaches. These characteristics suggest that practicing person-centeredness is an ongoing process, restarting with each clinical encounter. Because potential applications of person-centeredness are limitless, becoming person-centered must be learned and can be continually refined—something that appears to be well worth the effort for everyone involved.

Anna-Marie Schmidt, MM, DC, is a post-doctoral research scholar at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic.

Robert Vining, DC, DHSc, is associate dean of clinical research at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic.

 

References

  1. Greenfield G, Ignatowicz AM, Belsi A, et al. Wake up, wake up! It’s me! It’s my life! patient narratives on person-centeredness in the integrated care context: a qualitative study. BMC Health Serv Res. 2014;14(1). doi:10.1186/s12913-014-0619-9
  2. WHO | What is Quality of Care and why is it important? WHO. http://www.who.int/maternal_child_adolescent/topics/quality-of-care/definition/en/. Accessed February 21, 2019.
  3. Coulter ID, Herman PM, Ryan GW, Hays RD, Hilton LG, Whitley MD. Researching the Appropriateness of Care in the Complementary and Integrative Health Professions: Part I. J Manipulative Physiol Ther. February 2019. doi:10.1016/j.jmpt.2018.11.002
  4. Gray D, Barton B, Azam I, Bonnett D. 2017 National Healthcare Quality and Disparities Report. :130.
  5. VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain. 2017:110.
  6. National Institute for Health and Care Excellence. Falls in older people: assessing risk and prevention. 2013. nice.org.uk/guidance/cg161.
  7. Chou L, Ranger TA, Peiris W, et al. Patients’ perceived needs of health care providers for low back pain management: a systematic scoping review. Spine J. 2018;18(4):691-711. doi:10.1016/j.spinee.2018.01.006
  8. Bertakis KD, Azari R. Patient-Centered Care is Associated with Decreased Health Care Utilization. J Am Board Fam Med. 2011;24(3):229-239. doi:10.3122/jabfm.2011.03.100170
  9. Stewart M, Brown J, Donner A, et al. The Impact of Patient-Centered Care on Outcomes. J Fam Pract. September;49(9):796-804.
  10. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: Definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008;20(12):600-607. doi:10.1111/j.1745-7599.2008.00360.x
  11. Fiscella K, Meldrum S, Franks P, et al. Patient Trust. Med Care. 2004;42(11):1049-1055.
  12. Cousin G, Schmid Mast M, Roter DL, Hall JA. Concordance between physician communication style and patient attitudes predicts patient satisfaction. Patient Educ Couns. 2012;87(2):193-197. doi:10.1016/j.pec.2011.08.004
  13. Janisse T, Tallman K. Can All Doctors Be Like This? Seven Stories of Communication Transformation Told by Physicians Rated Highest by Patients. Perm J. 2017;21. doi:10.7812/TPP/16-097
  14. Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087-1110. doi:10.1016/S0277-9536(00)00098-8
  15. Egnew TR. The Art of Medicine: Seven Skills That Promote Mastery. Fam Pract Manag. 2014;21(4):25-30.
  16. Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor–patient congruence on satisfaction. Patient Educ Couns. 2000;39(1):49-59. doi:10.1016/S0738-3991(99)00090-7
  17. Stuber KJ, Langweiler M, Mior S, McCarthy PW. A pilot study assessing patient-centred care in patients with chronic health conditions attending chiropractic practice. Complement Ther Med. 2018;39:1-7. doi:10.1016/j.ctim.2018.05.006
  18. Trapp S, Stern M. Critical Synthesis Package: Patient-Practitioner Orientation Scale (PPOS). MedEdPORTAL. 2013;(9). doi:10.15766/mep_2374-8265.9501