The clinical case has been central to the practice of medicine since its inception, but the perceived value of the case, both a source of knowledge and as the basis for clinical decision making, has declined in the era of evidence-based medicine. Thinking in cases, however, is necessary for the practice of person-centered healthcare, ensuring that the individuality of the case-at-hand is recognized and incorporated into diagnostic and therapeutic decisions. The case-at-hand will be compared to other cases, derived from clinical research, pathophysiologic understanding, and clinical experience, as these kinds of cases serve as the repository of medical knowledge. Utilizing analogy and argument, clinicians derive and negotiate warrants relevant to particular patients, in order to make diagnoses, recommendations, and decisions. Case-based reasoning provides a rigorous and explicit framework for delivering person-centered care to individuals seeking healing.
{"title":"Case-based reasoning","authors":"M. Tonelli","doi":"10.5750/ejpch.v8i2.1844","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1844","url":null,"abstract":"The clinical case has been central to the practice of medicine since its inception, but the perceived value of the case, both a source of knowledge and as the basis for clinical decision making, has declined in the era of evidence-based medicine. Thinking in cases, however, is necessary for the practice of person-centered healthcare, ensuring that the individuality of the case-at-hand is recognized and incorporated into diagnostic and therapeutic decisions. The case-at-hand will be compared to other cases, derived from clinical research, pathophysiologic understanding, and clinical experience, as these kinds of cases serve as the repository of medical knowledge. Utilizing analogy and argument, clinicians derive and negotiate warrants relevant to particular patients, in order to make diagnoses, recommendations, and decisions. Case-based reasoning provides a rigorous and explicit framework for delivering person-centered care to individuals seeking healing.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74345549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"yes. and no.","authors":"J. Pheby","doi":"10.5750/ejpch.v8i2.1855","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1855","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"235 1","pages":"265-267"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76824342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this paper, an axiological analysis for the role of values in person-centered healthcare is undertaken from aesthetic, epistemic, and ethical perspectives, given the backdrop of a robust notion of personhood. To that end, personhood is first analyzed and conceptualized to provide a practical framework for situating the axiological analysis for the role of values, especially the value of human dignity, in healthcare. In terms of aesthetic values, beauty plays an essential role within person-centered healthcare, especially with respect to the value of wellbeing, and for providing a platform to analyze further both epistemic and ethical values in healthcare. With respect to epistemic values, truth - particularly in terms of the value of competence - plays a critical role in providing effective healthcare. In terms of ethical values, the good, especially with respect to the value of caring, plays a vital role in shaping how both clinicians and patients comport themselves in the clinical encounter. In a concluding section, the significance of the axiological analysis for the role of values in person-centered healthcare, in contrast to healthcare based on the biomedical model, is briefly discussed.
{"title":"Axiological analysis for the role of values in person-centered healthcare","authors":"J. Marcum","doi":"10.5750/ejpch.v8i2.1841","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1841","url":null,"abstract":"In this paper, an axiological analysis for the role of values in person-centered healthcare is undertaken from aesthetic, epistemic, and ethical perspectives, given the backdrop of a robust notion of personhood. To that end, personhood is first analyzed and conceptualized to provide a practical framework for situating the axiological analysis for the role of values, especially the value of human dignity, in healthcare. In terms of aesthetic values, beauty plays an essential role within person-centered healthcare, especially with respect to the value of wellbeing, and for providing a platform to analyze further both epistemic and ethical values in healthcare. With respect to epistemic values, truth - particularly in terms of the value of competence - plays a critical role in providing effective healthcare. In terms of ethical values, the good, especially with respect to the value of caring, plays a vital role in shaping how both clinicians and patients comport themselves in the clinical encounter. In a concluding section, the significance of the axiological analysis for the role of values in person-centered healthcare, in contrast to healthcare based on the biomedical model, is briefly discussed.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"105 1","pages":"183-192"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87884663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"our falling and wretchedness","authors":"J. Pheby","doi":"10.5750/ejpch.v8i2.1853","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1853","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"16 1","pages":"260-262"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85004978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In health economics, value has usually been understood within the framework of the production and consumption of healthcare. Two tools of measurement, efficiency and equity, have been used to make decisions on healthcare resources. However, the healthcare system is also not a market like others, and applying the criteria of efficiency and equity to the field of health calls for significant adaptation. In addition, even when epistemologically informed and technically equipped, care is also attention and an engagement toward the person for whom the care is directed. Current models fail to take into consideration the individual, qualitative nature of individual patient experience, but also the wider environment affecting the patient’s health outcomes. Therefore tensions continue to exist between value as understood in a health economics perspective and the relational values promoted in proposals of person-centered care. Healthcare values are plural and explain what one commits to in terms of actions and relationships with others. Taking into account this plurality reminds us both of the ethical dimension of care but also how it is made possible through financing. Person-centered care therefore calls for new models of evaluation, ones which will understand the values of care for the person in their personal and professional contexts.
{"title":"The Meaning of Value in “Person-centred” approaches to Healthcare","authors":"J. Pierron, Didier Vinot","doi":"10.5750/ejpch.v8i2.1842","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1842","url":null,"abstract":"In health economics, value has usually been understood within the framework of the production and consumption of healthcare. Two tools of measurement, efficiency and equity, have been used to make decisions on healthcare resources. However, the healthcare system is also not a market like others, and applying the criteria of efficiency and equity to the field of health calls for significant adaptation. In addition, even when epistemologically informed and technically equipped, care is also attention and an engagement toward the person for whom the care is directed. Current models fail to take into consideration the individual, qualitative nature of individual patient experience, but also the wider environment affecting the patient’s health outcomes. Therefore tensions continue to exist between value as understood in a health economics perspective and the relational values promoted in proposals of person-centered care. Healthcare values are plural and explain what one commits to in terms of actions and relationships with others. Taking into account this plurality reminds us both of the ethical dimension of care but also how it is made possible through financing. Person-centered care therefore calls for new models of evaluation, ones which will understand the values of care for the person in their personal and professional contexts.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"86 1","pages":"193-200"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81169075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical Commentary on Pheby, J. (2020). to be nothing but pain EJPCH 8 (2) 270-272","authors":"D. Pheby","doi":"10.5750/ejpch.v8i2.1858","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1858","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"106 1","pages":"273-274"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76933561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Person-centred care and co-production may seem to have the potential to work hand-in-hand, with co-production poised to support services in their aims of centring persons as equal agents in their own care. Equally, there seem inherent tensions in pursuing co-production in a socio-political climate that gauges the value of services in terms of a narrow sense of economic efficiency. This article explores those tensions, and what we argue is the false neutrality of neoliberal assumptions about value. We offer a critique of the possibility of achieving meaningful person-centred care, or meaningful coproduction, in such a context. We set out the commitments of person-centred care, and explore how coproduction might assist in the realisation of each of those promises - as well as the material and interpersonal conditions that limit and constrain both person-centred care and co-production. We invite the reader to consider a social model of co-production, in which the possibility of the equal creation of care may be realised.
{"title":"Co-production and person-centred care in neoliberal conditions","authors":"Nicola Blunden, Gideon Calder","doi":"10.5750/EJPCH.V8I1.1822","DOIUrl":"https://doi.org/10.5750/EJPCH.V8I1.1822","url":null,"abstract":"Person-centred care and co-production may seem to have the potential to work hand-in-hand, with co-production poised to support services in their aims of centring persons as equal agents in their own care. Equally, there seem inherent tensions in pursuing co-production in a socio-political climate that gauges the value of services in terms of a narrow sense of economic efficiency. This article explores those tensions, and what we argue is the false neutrality of neoliberal assumptions about value. We offer a critique of the possibility of achieving meaningful person-centred care, or meaningful coproduction, in such a context. We set out the commitments of person-centred care, and explore how coproduction might assist in the realisation of each of those promises - as well as the material and interpersonal conditions that limit and constrain both person-centred care and co-production. We invite the reader to consider a social model of co-production, in which the possibility of the equal creation of care may be realised.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"63 1","pages":"75-85"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91072244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this issue of the Journal, we begin the serialisation of a seminal new text which has significantly advanced current understandings of the conceptual basis of person-centered care (PCC) [1]. The volume, edited by Michael Loughlin and Andrew Miles, brings together 42 distinguished scholars, writing over the course of 28 chapters, divided into 6 definitive sections, spanning some 420 pages of text. Each of the chapters has distinct merit and, when studied collectively, the scale of their contribution to current thinking in the field becomes quickly apparent. The volume is scheduled for production towards the end of the current year and will be published by Aesculapius Medical Press (AMP), the publishing Imprint of the European Society for Person Centered Healthcare (ESPCH). A detailed overview of the volume has been provided by Loughlin, the lead co-editor of the book [2]. Loughlin’s paper [2] is a model of clarity, providing admirable insight into the content of the individual chapters, placing each of them within the context of the ongoing debate. As Loughlin [2] rightly notes, “the ideas and terminology of person-centred care ... have been part of health discourse for a very long time ... (and) ... arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity” (italicisation mine). He emphasises that “... it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and associated ideas including patient expertise, co-production and shared decision-making, are not simply fine ideals or ethical add-ons to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice” (italicisations mine). These observations, indeed truisms, explain the rationale which underpinned the creation of the European Society for Person Centered Healthcare, and which continue to direct its mission.
{"title":"Progress in the conceptual understanding of person-centered health and social care. ‘Person Centered Care: Advanced Philosophical Perspectives’. Loughlin, M. & Miles, A. (Eds). 2020. London: Aesculapius Medical Press.","authors":"J. Asbridge","doi":"10.5750/EJPCH.V8I1.1799","DOIUrl":"https://doi.org/10.5750/EJPCH.V8I1.1799","url":null,"abstract":"In this issue of the Journal, we begin the serialisation of a seminal new text which has significantly advanced current understandings of the conceptual basis of person-centered care (PCC) [1]. The volume, edited by Michael Loughlin and Andrew Miles, brings together 42 distinguished scholars, writing over the course of 28 chapters, divided into 6 definitive sections, spanning some 420 pages of text. Each of the chapters has distinct merit and, when studied collectively, the scale of their contribution to current thinking in the field becomes quickly apparent. The volume is scheduled for production towards the end of the current year and will be published by Aesculapius Medical Press (AMP), the publishing Imprint of the European Society for Person Centered Healthcare (ESPCH). A detailed overview of the volume has been provided by Loughlin, the lead co-editor of the book [2]. Loughlin’s paper [2] is a model of clarity, providing admirable insight into the content of the individual chapters, placing each of them within the context of the ongoing debate. As Loughlin [2] rightly notes, “the ideas and terminology of person-centred care ... have been part of health discourse for a very long time ... (and) ... arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity” (italicisation mine). He emphasises that “... it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and associated ideas including patient expertise, co-production and shared decision-making, are not simply fine ideals or ethical add-ons to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice” (italicisations mine). These observations, indeed truisms, explain the rationale which underpinned the creation of the European Society for Person Centered Healthcare, and which continue to direct its mission.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"57 1","pages":"17-19"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91359844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Is person centred care merely a humanitarian addition to good medical practice - considering the person’s personal needs and wishes on top of mending the body? Or is it a truly fundamental essential of good practice in the way that hygiene was in the 19th Century? Is there a compelling (rather than merely desirable) reason for being person-centred? This chapter defends the claim that the holistic person is primal to understanding human health and healthcare. Human beings are organisms, not mechanisms, and there are fundamental differences between the two. Organisms are essentially whole at all stages of their development, whereas machines are not whole until assembled from component parts. In addition, organisms are always in transition in response to the ever-changing environment. While these distinctions have been recognised since the ancients, medicine in the modern era has largely focused on body mechanisms for its theory and practice. Dramatic increases in knowledge and technological innovation have led to a focus on the body as a machine and a failure to consider the implications of the organism for human health. The chapter argues that, in contrast to current thinking, a person is not constituted by the capacity of their genes and molecular mechanisms, etc ., but by their unique set of experiences together with a narrative that interprets and gives meaning to them. The role of genes along with other body mechanisms is not so much to provide a blue-print for body growth and development, as a means of responding and adapting to environmental resources and challenges. It is the essence of those responses that forms the core of human experiences in all domains.
{"title":"Person-Centred Care: Putting the Organic Horse back in front of the Mechanical Cart","authors":"S. Tyreman","doi":"10.5750/EJPCH.V8I1.1823","DOIUrl":"https://doi.org/10.5750/EJPCH.V8I1.1823","url":null,"abstract":"Is person centred care merely a humanitarian addition to good medical practice - considering the person’s personal needs and wishes on top of mending the body? Or is it a truly fundamental essential of good practice in the way that hygiene was in the 19th Century? Is there a compelling (rather than merely desirable) reason for being person-centred? This chapter defends the claim that the holistic person is primal to understanding human health and healthcare. Human beings are organisms, not mechanisms, and there are fundamental differences between the two. Organisms are essentially whole at all stages of their development, whereas machines are not whole until assembled from component parts. In addition, organisms are always in transition in response to the ever-changing environment. While these distinctions have been recognised since the ancients, medicine in the modern era has largely focused on body mechanisms for its theory and practice. Dramatic increases in knowledge and technological innovation have led to a focus on the body as a machine and a failure to consider the implications of the organism for human health. The chapter argues that, in contrast to current thinking, a person is not constituted by the capacity of their genes and molecular mechanisms, etc ., but by their unique set of experiences together with a narrative that interprets and gives meaning to them. The role of genes along with other body mechanisms is not so much to provide a blue-print for body growth and development, as a means of responding and adapting to environmental resources and challenges. It is the essence of those responses that forms the core of human experiences in all domains.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"12 1","pages":"86-93"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89185189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Both the Evidence Based Medicine (EBM) and Person Centered Healthcare (PCH) movements recognize that decisions on how to manage the care of individual patients in the clinical encounter require more than simple application of those therapies shown effective in a clinical trial. GRADE, a popular framework for developing clinical recommendations, identifies patient “values and preferences” as an important consideration in clinical decision making and a component in determining a clinical recommendation and its strength. However, how patient “values and preferences” are conceptualized in GRADE are problematic if one believes the individual patient’s care should be aligned with her values and preferences. GRADE focuses on “typical” patient “values and preferences” in the process of determining the recommendation. There is no guarantee that the values and preferences of the typical patient will represent that of the individual patient in the clinical encounter. Furthermore, the strength of the recommendation (“strong” vs . “weak”) appears to impact how much patient engagement is warranted (under GRADE), which affects the extent to which information on the “values and preferences” of the individual patient will be sought out or revealed in the clinical encounter. The issues raised in this paper stem from a lack of an underlying theory and empirical support to explain why certain elements have been included in the framework, and others not. A failure to clearly define, operationalize, and measure a patient’s “values and preferences” may limit the value of GRADE derived recommendations and subsequent clinical practice guidelines in managing the care of individual patients consistent with PCH.
{"title":"Defining the meaning, role, and measurement of “values and preferences” in the development of practice guidelines: The case of GRADE","authors":"M. Mercuri, A. Gafni","doi":"10.5750/EJPCH.V8I1.1819","DOIUrl":"https://doi.org/10.5750/EJPCH.V8I1.1819","url":null,"abstract":"Both the Evidence Based Medicine (EBM) and Person Centered Healthcare (PCH) movements recognize that decisions on how to manage the care of individual patients in the clinical encounter require more than simple application of those therapies shown effective in a clinical trial. GRADE, a popular framework for developing clinical recommendations, identifies patient “values and preferences” as an important consideration in clinical decision making and a component in determining a clinical recommendation and its strength. However, how patient “values and preferences” are conceptualized in GRADE are problematic if one believes the individual patient’s care should be aligned with her values and preferences. GRADE focuses on “typical” patient “values and preferences” in the process of determining the recommendation. There is no guarantee that the values and preferences of the typical patient will represent that of the individual patient in the clinical encounter. Furthermore, the strength of the recommendation (“strong” vs . “weak”) appears to impact how much patient engagement is warranted (under GRADE), which affects the extent to which information on the “values and preferences” of the individual patient will be sought out or revealed in the clinical encounter. The issues raised in this paper stem from a lack of an underlying theory and empirical support to explain why certain elements have been included in the framework, and others not. A failure to clearly define, operationalize, and measure a patient’s “values and preferences” may limit the value of GRADE derived recommendations and subsequent clinical practice guidelines in managing the care of individual patients consistent with PCH.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"95 1","pages":"45-57"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76857474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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