Aim: To provide a person-centered set of recommendations that will help (i) healthcare professionals to implement the medication review process at hospital and (ii) tactical stakeholders to promote medication reviews as standard practice in clinical pharmacy. Background: Although the medication review process is highly relevant for the safety of individual patients and for economic purposes, it appears to be complex to implement and then maintain over time in hospital settings. The stakeholders who implement the medication review process may feel disempowered and often request guidance on how to overcome these problems. Method: We first drew up the most comprehensive possible list of barriers and facilitators (i.e., factors that respectively hinder or help the medication review process at hospitals) by searching the PubMed, Web of Science, and Science Direct databases for case studies describing the implementation of medication reconciliation and medication review processes in hospital settings. Text extracts mentioning facilitators and barriers were divided into thematic units, analysed and classified hierarchically. Based on this list of influencing factors, we developed a series of person-centered recommendations. Results: The analysis of 38 publications led to the identification of 617 factors (346 facilitators and 271 barriers) divided into 9 categories and 67 subcategories. Next, we developed a set of 71 specific recommendations for operational stakeholders on designing, implementing and performing the MRev process at hospital. The recommendations are divided into 6 main categories: Designing the process , Participants , Training , Tools , Information and Organization . We also elaborated a set of 20 key recommendations for local and national decision-makers on sustaining the implementation of the MRev process at hospital. Conclusion: We identified a large number of factors that may impact the implementation of the MRev process at hospital and which therefore have the potential to impact upon person-centeredness. Based on this list, we provide a set of recommendations for operational and tactical stakeholders on supporting the local implementation and nationwide expansion of the MRev process.
目的:提供一套以人为本的建议，以帮助(i)医疗保健专业人员在医院实施药物审查过程，(ii)战术利益相关者促进药物审查作为临床药学的标准实践。背景:尽管药物审查过程与个体患者的安全性和经济目的高度相关，但在医院环境中实施和维持这一过程似乎很复杂。实施药物审查过程的利益相关者可能会感到被剥夺了权力，并经常要求指导如何克服这些问题。方法:我们首先通过检索PubMed、Web of Science和Science Direct数据库中描述在医院环境中实施药物和解和药物审查过程的案例研究，列出了最全面的障碍和促进因素(即分别阻碍或帮助医院药物审查过程的因素)。将提及促进因素和障碍因素的文本摘录分成专题单元，分层次进行分析和分类。基于这些影响因素，我们提出了一系列以人为本的建议。结果:通过对38篇文献的分析，共识别出617个影响因素，其中促进因素346个，阻碍因素271个，分为9大类67亚类。接下来，我们为运营利益相关者在医院设计、实施和执行MRev流程制定了一套71条具体建议。这些建议分为6个主要类别:设计过程、参与者、培训、工具、信息和组织。我们还为地方和国家决策者制定了一套20项关于在医院持续实施MRev进程的关键建议。结论:我们确定了大量可能影响医院实施MRev流程的因素，因此这些因素可能会影响以人为本。基于这份清单，我们为业务和战术利益相关者提供了一套建议，以支持MRev进程在当地的实施和在全国范围内的扩展。
{"title":"Implementing a person-centered medication review process at hospital: Recommendations based on a scoping review of barriers and facilitators","authors":"C. Wawrzyniak, R. Marcilly, L. Douze, S. Pelayo","doi":"10.5750/EJPCH.V7I4.1776","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1776","url":null,"abstract":"Aim: To provide a person-centered set of recommendations that will help (i) healthcare professionals to implement the medication review process at hospital and (ii) tactical stakeholders to promote medication reviews as standard practice in clinical pharmacy. Background: Although the medication review process is highly relevant for the safety of individual patients and for economic purposes, it appears to be complex to implement and then maintain over time in hospital settings. The stakeholders who implement the medication review process may feel disempowered and often request guidance on how to overcome these problems. Method: We first drew up the most comprehensive possible list of barriers and facilitators (i.e., factors that respectively hinder or help the medication review process at hospitals) by searching the PubMed, Web of Science, and Science Direct databases for case studies describing the implementation of medication reconciliation and medication review processes in hospital settings. Text extracts mentioning facilitators and barriers were divided into thematic units, analysed and classified hierarchically. Based on this list of influencing factors, we developed a series of person-centered recommendations. Results: The analysis of 38 publications led to the identification of 617 factors (346 facilitators and 271 barriers) divided into 9 categories and 67 subcategories. Next, we developed a set of 71 specific recommendations for operational stakeholders on designing, implementing and performing the MRev process at hospital. The recommendations are divided into 6 main categories: Designing the process , Participants , Training , Tools , Information and Organization . We also elaborated a set of 20 key recommendations for local and national decision-makers on sustaining the implementation of the MRev process at hospital. Conclusion: We identified a large number of factors that may impact the implementation of the MRev process at hospital and which therefore have the potential to impact upon person-centeredness. Based on this list, we provide a set of recommendations for operational and tactical stakeholders on supporting the local implementation and nationwide expansion of the MRev process.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"210 1","pages":"547-575"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74151406","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}
a Professor of Person Centred Health and Social Care & Co-Director, European Institute for Person Centred Health and Social Care, University of West London; Senior Vice President/Secretary General, European Society for Person Centered Healthcare/Editor-in-Chief, European Journal for Person Centered Healthcare & Honorary Professor of Person Centred Care, Centre for Public Engagement, St. George’s University Hospital Campus, University of London, UK b President & Chairman of Council, European Society for Person Centered Healthcare; Chief Clinical Officer, Healthcare At Home/Deputy Chairman, Oxford Healthcare NHS Trust, England, UK; Chairman, Editorial Board, European Journal for Person Centered Healthcare and Visiting Senior Clinical Professor, European Institute for Person Centred Health and Social Care, University of West London, UK
{"title":"Engaging patients and their caregivers/representatives in person-centered clinical guidelines development. A commentary on Khodyakov et al. (2019) EJPCH 7 (3) 470-475 & Armstrong et al. (2019) EJPCH 7 (3) 476-489","authors":"A. Miles, J. Asbridge","doi":"10.5750/EJPCH.V7I4.1875","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1875","url":null,"abstract":"a Professor of Person Centred Health and Social Care & Co-Director, European Institute for Person Centred Health and Social Care, University of West London; Senior Vice President/Secretary General, European Society for Person Centered Healthcare/Editor-in-Chief, European Journal for Person Centered Healthcare & Honorary Professor of Person Centred Care, Centre for Public Engagement, St. George’s University Hospital Campus, University of London, UK b President & Chairman of Council, European Society for Person Centered Healthcare; Chief Clinical Officer, Healthcare At Home/Deputy Chairman, Oxford Healthcare NHS Trust, England, UK; Chairman, Editorial Board, European Journal for Person Centered Healthcare and Visiting Senior Clinical Professor, European Institute for Person Centred Health and Social Care, University of West London, UK","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"88 1","pages":"665-670"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90879492","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}
Y. Lee, C. Bryce, Sandeep K Jain, J. Kraschnewski, K. McTigue
Objective: To develop and validate a patient-centered visualization approach to support decision-making by patients who are choosing between two hypothetic therapeutic options. Methods: Infographics that contrast two hypothetical drugs, Drug A (low benefit/low risk) and Drug B (high benefit/high risk), were developed based on the input of the clinicians and patients. We adopted a crowdsourcing approach to test the association of a stakeholder-informed infographic, versus text-based educational information, with audience understanding of the risks and benefits of therapeutic options and with decision-making concerning a particular therapeutic option. Results: The low benefit/low risk drug was consistently preferred over high benefit/high risk. The importance that people placed on potential benefits was consistently associated with medication choice. Perceived importance of medication harms was associated with medication choice only among low-risk patients. Information display (textual versus infographic) and user literacy were not associated with medication choice. Conclusion: This study demonstrated that patient-centered infographics can be developed using participatory design to support patient decision-making process. The potential benefits of a drug was the most consistent predictor of medication choice in the study. Practice Implications: Participatory design and crowdsourcing demonstrates promise to facilitate the participatory design of educational materials necessary for shared-decision making.
{"title":"Patient-centered visualization on supporting patients’ decision-making","authors":"Y. Lee, C. Bryce, Sandeep K Jain, J. Kraschnewski, K. McTigue","doi":"10.5750/EJPCH.V7I4.1783","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1783","url":null,"abstract":"Objective: To develop and validate a patient-centered visualization approach to support decision-making by patients who are choosing between two hypothetic therapeutic options. Methods: Infographics that contrast two hypothetical drugs, Drug A (low benefit/low risk) and Drug B (high benefit/high risk), were developed based on the input of the clinicians and patients. We adopted a crowdsourcing approach to test the association of a stakeholder-informed infographic, versus text-based educational information, with audience understanding of the risks and benefits of therapeutic options and with decision-making concerning a particular therapeutic option. Results: The low benefit/low risk drug was consistently preferred over high benefit/high risk. The importance that people placed on potential benefits was consistently associated with medication choice. Perceived importance of medication harms was associated with medication choice only among low-risk patients. Information display (textual versus infographic) and user literacy were not associated with medication choice. Conclusion: This study demonstrated that patient-centered infographics can be developed using participatory design to support patient decision-making process. The potential benefits of a drug was the most consistent predictor of medication choice in the study. Practice Implications: Participatory design and crowdsourcing demonstrates promise to facilitate the participatory design of educational materials necessary for shared-decision making.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"34 1","pages":"630-639"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78354613","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}
D. Taubman, Lizelle Salazar, Stephanie Salazar, S. Parikh
Background, aims and objectives: Teachers and other school personnel are often the first point of contact for a student who is experiencing mental distress. They are therefore particularly well-placed to provide ongoing social and emotional support to students. Nevertheless, most school personnel are not trained to recognize and respond to mental health problems. Methods: In order to better understand the needs and challenges around student mental health and improve school mental health interventions and resources, we used quantitative and qualitative survey items to compare the perspectives of both school staff and students. To obtain personnel feedback, a 14-item online survey was distributed at the primary and secondary school levels. To obtain student feedback, 7 survey items were added to an existing school-based program survey that was distributed at participating high schools. Results: Out of 32 schools surveyed, 254 personnel responded, including 60 high school personnel. In addition, 756 students responded from 10 high schools. Though there is agreement between personnel and students on the need to address student mental health issues, there is an apparent disconnect between reports on what is being done and what needs to go into supporting student mental health. Conclusion: Along with teachers and other school personnel, students should be part of the needs assessment and priority setting processes around school mental health. Strategies to improve student mental health programs and practices are addressed.
{"title":"Bridging the Gap: Comparing School Personnel and Student Perspectives on the Mental Health Needs of Students","authors":"D. Taubman, Lizelle Salazar, Stephanie Salazar, S. Parikh","doi":"10.5750/EJPCH.V7I4.1785","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1785","url":null,"abstract":"Background, aims and objectives: Teachers and other school personnel are often the first point of contact for a student who is experiencing mental distress. They are therefore particularly well-placed to provide ongoing social and emotional support to students. Nevertheless, most school personnel are not trained to recognize and respond to mental health problems. Methods: In order to better understand the needs and challenges around student mental health and improve school mental health interventions and resources, we used quantitative and qualitative survey items to compare the perspectives of both school staff and students. To obtain personnel feedback, a 14-item online survey was distributed at the primary and secondary school levels. To obtain student feedback, 7 survey items were added to an existing school-based program survey that was distributed at participating high schools. Results: Out of 32 schools surveyed, 254 personnel responded, including 60 high school personnel. In addition, 756 students responded from 10 high schools. Though there is agreement between personnel and students on the need to address student mental health issues, there is an apparent disconnect between reports on what is being done and what needs to go into supporting student mental health. Conclusion: Along with teachers and other school personnel, students should be part of the needs assessment and priority setting processes around school mental health. Strategies to improve student mental health programs and practices are addressed.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"9 1","pages":"640-649"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87157138","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}
J. Howick, S. J. Kennedy, J. Myerscough, M. Mosley, C. Madigan
Background: Systematic reviews of randomized trials show that empathic care (a core component of person-centered care) and placebos can reduce chronic back pain. However, this evidence has rarely been implemented and public knowledge of empathy and placebos is limited. Objectives: We conducted a trial (‘OPTICARE’) in a real-life setting. The trial and its aftermath were filmed for a British Broadcasting Corporation (BBC) Horizon documentary. Methods: Eligible participants aged 18-75 years with self-reported persistent back pain (>3 months) were randomised to: (1) Control group (SC): had a standard consultation and a leaflet describing NHS recommendations for back pain. (2) Standard placebo group (SP): received a three-week course of placebo pills (2 capsules, twice a day) and a standard (5-10 minute) general practice (GP) consultation. (3) Empathy and placebo group (EP): received the same as SP treatment as the standard placebo group and a longer (15-30 minute) consultation with a doctor prompted to be highly empathetic. Self-reported changes in pain after 3 weeks were measured using the Visual Analogue Scale and the Roland Morris Disability Questionnaire. The process was filmed by Windfall Films. Results: The documentary, entitled ‘The Placebo Experiment: Can My Brain Cure My Body?’ was first broadcast on BBC Two in the UK on 4 October 2018. It was watched by 1.9 million people. Almost all of the 117 participants in the trial reported a reduction in pain and magnitude of placebo effects is similar in real world settings as it is in clinical trials. Conclusions: This was the largest placebo study we are aware of that was conducted with a main purpose of educating the public about placebo effects and the first known published report of a study designed for a documentary. Although the trial suffered from a number of limitations, including contamination and lack of power, it is contended that randomised trials of placebo treatments can be conducted so that they benefit and educate the public.
{"title":"BBC Horizon placebo back pain study: a public trial of the effectiveness of placebos","authors":"J. Howick, S. J. Kennedy, J. Myerscough, M. Mosley, C. Madigan","doi":"10.5750/EJPCH.V7I4.1787","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1787","url":null,"abstract":"Background: Systematic reviews of randomized trials show that empathic care (a core component of person-centered care) and placebos can reduce chronic back pain. However, this evidence has rarely been implemented and public knowledge of empathy and placebos is limited. Objectives: We conducted a trial (‘OPTICARE’) in a real-life setting. The trial and its aftermath were filmed for a British Broadcasting Corporation (BBC) Horizon documentary. Methods: Eligible participants aged 18-75 years with self-reported persistent back pain (>3 months) were randomised to: (1) Control group (SC): had a standard consultation and a leaflet describing NHS recommendations for back pain. (2) Standard placebo group (SP): received a three-week course of placebo pills (2 capsules, twice a day) and a standard (5-10 minute) general practice (GP) consultation. (3) Empathy and placebo group (EP): received the same as SP treatment as the standard placebo group and a longer (15-30 minute) consultation with a doctor prompted to be highly empathetic. Self-reported changes in pain after 3 weeks were measured using the Visual Analogue Scale and the Roland Morris Disability Questionnaire. The process was filmed by Windfall Films. Results: The documentary, entitled ‘The Placebo Experiment: Can My Brain Cure My Body?’ was first broadcast on BBC Two in the UK on 4 October 2018. It was watched by 1.9 million people. Almost all of the 117 participants in the trial reported a reduction in pain and magnitude of placebo effects is similar in real world settings as it is in clinical trials. Conclusions: This was the largest placebo study we are aware of that was conducted with a main purpose of educating the public about placebo effects and the first known published report of a study designed for a documentary. Although the trial suffered from a number of limitations, including contamination and lack of power, it is contended that randomised trials of placebo treatments can be conducted so that they benefit and educate the public.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"65 1","pages":"650-655"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88318985","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}
Background: Depression is the most common mental health co-morbidity experienced by people living with HIV. We developed an intervention to improve mental health among HIV-infected individuals. The aim was to improve each person’s balance in life, making each person conscious about their own behavior and activating their own resources. The participant worked with their individual process within the group and practised techniques to address fear/stress management. Mental health improved overall and there was a significant decrease in depression. The effect was maintained at 12-months.This study aimed to gain insight into factors that mediated the effects observed. Methods: Semi-structured interviews were conducted with each participant at the end of the intervention. Digital audio-recordings of the 48 interviews were transcribed and analyzed using thematic analysis. Results: The following themes were identified as facilitators: Context, Participant, Coach, Intervention approach and Sense of Community . Three themes explained the experienced effect: Transformation, Internalized Stigma Changes and Integrity. We observed that fear no longer controlled the lives of the participants, as the individuals acquired new skills to handle disclosure and internalized stigma. Living with HIV became an integrated part of their life. Conclusion: Interventions designed to practise and strengthen patients’ insight into the mental and physical contexts of their condition reduces depression, improves mental health and quality of life and should be offered in conjunction with HIV medication and be a fully integrated aspect of HIV care. Thus, treatment calls for a holistic and person-centered approach to patient care, acknowledging that viral suppression is not necessarily the ultimate goal of effective treatment.
{"title":"“I am a whole person, not a diagnosis” - A mind-body intervention to improve the mental wellbeing of HIV-infected individuals in Denmark","authors":"L. Rodkjaer, T. Laursen, K. Seeberg","doi":"10.5750/EJPCH.V7I4.1780","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1780","url":null,"abstract":"Background: Depression is the most common mental health co-morbidity experienced by people living with HIV. We developed an intervention to improve mental health among HIV-infected individuals. The aim was to improve each person’s balance in life, making each person conscious about their own behavior and activating their own resources. The participant worked with their individual process within the group and practised techniques to address fear/stress management. Mental health improved overall and there was a significant decrease in depression. The effect was maintained at 12-months.This study aimed to gain insight into factors that mediated the effects observed. Methods: Semi-structured interviews were conducted with each participant at the end of the intervention. Digital audio-recordings of the 48 interviews were transcribed and analyzed using thematic analysis. Results: The following themes were identified as facilitators: Context, Participant, Coach, Intervention approach and Sense of Community . Three themes explained the experienced effect: Transformation, Internalized Stigma Changes and Integrity. We observed that fear no longer controlled the lives of the participants, as the individuals acquired new skills to handle disclosure and internalized stigma. Living with HIV became an integrated part of their life. Conclusion: Interventions designed to practise and strengthen patients’ insight into the mental and physical contexts of their condition reduces depression, improves mental health and quality of life and should be offered in conjunction with HIV medication and be a fully integrated aspect of HIV care. Thus, treatment calls for a holistic and person-centered approach to patient care, acknowledging that viral suppression is not necessarily the ultimate goal of effective treatment.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"40 1","pages":"614-622"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81388284","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}
Joanne Reeve, J. Seymour, Myriam. Dell Olio, S. Pask
Introduction Growing numbers of people now live with long term conditions. For each person, the challenges are multiple and unique to that individual. In recognition of this, health policy places greater emphasis on the delivery of person-centred care (PCC). However, patients report declining levels of such care. One reason for this may be a mismatch between patient and professional/policy understanding of PCC. Aim To understand PCC from the perspectives of people with long-term conditions. Methods A systematic review of qualitative literature was conducted. Databases searched included ASSIA, BNI, CINAHL, the Cochrane Library, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Science, and grey literature databases. Two reviewers independently screened and selected the studies, assessed their quality, and extracted data. Fifty-four records were analysed through meta-ethnography. Results Four themes emerged: the healthcare system as a battlefield, the healthcare system as a maze, patients’ accounts of personhood, and the centrality of patient enablement. A person-centred healthcare system is described by this review as one that values personhood and enables patients to build knowledge with their clinician in order to manage their illness in a safe, caring, and accessible environment. Conclusion PCC does not depend on the efforts of the clinician alone, but results from a collaboration with the patient and needs to be enabled by the wider organisational and educational systems. Efforts directed at the implementation of PCC might be bound to fail if the healthcare policy agenda does not address the role of the patient’s personhood in clinical practice, and its integration in educational settings.
越来越多的人患有长期疾病。对每个人来说，挑战都是多重的，对每个人来说都是独一无二的。认识到这一点，卫生政策更加强调提供以人为本的护理。然而，患者报告这种护理水平正在下降。造成这种情况的一个原因可能是患者与专业/政策对PCC的理解不匹配。目的从长期患者的角度了解PCC。方法系统回顾定性文献。检索的数据库包括ASSIA、BNI、CINAHL、Cochrane Library、Embase、Medline、PsycINFO、PubMed、Scopus、Web of Science和灰色文献数据库。两名审稿人独立筛选和选择研究，评估其质量，并提取数据。通过元民族志分析了54份记录。结果出现了四个主题:医疗系统作为战场，医疗系统作为迷宫，患者对人格的描述，以及患者使能的中心地位。本综述将以人为本的医疗保健系统描述为重视人格，使患者能够与临床医生建立知识，以便在安全，关怀和无障碍的环境中管理他们的疾病。结论PCC不依赖于临床医生单独的努力，而是与患者合作的结果，需要更广泛的组织和教育系统的支持。如果医疗保健政策议程不能解决患者人格在临床实践中的作用，并将其与教育环境相结合，那么针对PCC实施的努力可能注定会失败。
{"title":"What do the healthcare experiences of people with long-term conditions tell us about person-centred care? A systematic review.","authors":"Joanne Reeve, J. Seymour, Myriam. Dell Olio, S. Pask","doi":"10.5750/EJPCH.V7I4.1779","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I4.1779","url":null,"abstract":"Introduction \u0000Growing numbers of people now live with long term conditions. For each person, the challenges are multiple and unique to that individual. In recognition of this, health policy places greater emphasis on the delivery of person-centred care (PCC). However, patients report declining levels of such care. One reason for this may be a mismatch between patient and professional/policy understanding of PCC. \u0000Aim \u0000To understand PCC from the perspectives of people with long-term conditions. \u0000Methods \u0000A systematic review of qualitative literature was conducted. Databases searched included ASSIA, BNI, CINAHL, the Cochrane Library, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Science, and grey literature databases. Two reviewers independently screened and selected the studies, assessed their quality, and extracted data. Fifty-four records were analysed through meta-ethnography. \u0000Results \u0000Four themes emerged: the healthcare system as a battlefield, the healthcare system as a maze, patients’ accounts of personhood, and the centrality of patient enablement. A person-centred healthcare system is described by this review as one that values personhood and enables patients to build knowledge with their clinician in order to manage their illness in a safe, caring, and accessible environment. \u0000Conclusion \u0000PCC does not depend on the efforts of the clinician alone, but results from a collaboration with the patient and needs to be enabled by the wider organisational and educational systems. Efforts directed at the implementation of PCC might be bound to fail if the healthcare policy agenda does not address the role of the patient’s personhood in clinical practice, and its integration in educational settings.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76373084","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}
A. Beck, H. V. Thaysen, C. Soegaard, J. Blaakær, L. Seibæk
Background: The aim of the study was to investigate cancer patients’ perspectives on a pre-defined, home-based, multimodal prehabilitation programme with particular attention to feasibility and acceptability. Patients and methods: Fifteen patients with peritoneal carcinomatosis of colorectal or ovarian origin undergoing complete cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC), participated in semi-structured interviews. Malterud’s principles of systematic text condensation were used to analyse the data. Results: Patients had a positive attitude towards home-based prehabilitation, primarily because of the opportunity to influence recovery, but also because it could distract their attention from negative thoughts and because they could gain support. However, they would not follow the programme unconditionally and significant barriers to adherence were identified. These included lack of belief, everyday life, preferences and restrictions . Conclusion: Patients’ perspectives on home-based prehabilitation contribute new knowledge concerning barriers to adherence to a programme. The findings underscore the complexity of developing a home-based, multimodal prehabilitation programme that not only enhances functional capacity, but is also experienced relevant to the patients and aligns with the demands of their everyday lives.
{"title":"From waiting to preparing: A qualitative feasibility study of cancer patients’ perspectives on prehabilitation","authors":"A. Beck, H. V. Thaysen, C. Soegaard, J. Blaakær, L. Seibæk","doi":"10.5750/EJPCH.V7I3.1738","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I3.1738","url":null,"abstract":"Background: The aim of the study was to investigate cancer patients’ perspectives on a pre-defined, home-based, multimodal prehabilitation programme with particular attention to feasibility and acceptability. Patients and methods: Fifteen patients with peritoneal carcinomatosis of colorectal or ovarian origin undergoing complete cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC), participated in semi-structured interviews. Malterud’s principles of systematic text condensation were used to analyse the data. Results: Patients had a positive attitude towards home-based prehabilitation, primarily because of the opportunity to influence recovery, but also because it could distract their attention from negative thoughts and because they could gain support. However, they would not follow the programme unconditionally and significant barriers to adherence were identified. These included lack of belief, everyday life, preferences and restrictions . Conclusion: Patients’ perspectives on home-based prehabilitation contribute new knowledge concerning barriers to adherence to a programme. The findings underscore the complexity of developing a home-based, multimodal prehabilitation programme that not only enhances functional capacity, but is also experienced relevant to the patients and aligns with the demands of their everyday lives.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"73 1","pages":"443-453"},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89449721","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, I discuss Lonergan’s account of the structure of the human good and then demonstrate how it works in reference to a doctor’s description of her experience at a New Orleans’ hospital in the aftermath of Hurricane Katrina. Next, I proceed to define health and disease on the basis of Lonergan’s accounts of the human good, emergent probability and generalized empirical method. Then, I lay out the generic levels of human living in a table of terms whose interrelations embody the multiple dimensions of health and their dynamic potential for integration (and breakdown) in the GEM model of health.
{"title":"The GEM model of health: a model based on generalized empirical method –Part 3 – Fleshing out the model","authors":"P. Daly","doi":"10.5750/EJPCH.V7I3.1727","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I3.1727","url":null,"abstract":"In this paper, I discuss Lonergan’s account of the structure of the human good and then demonstrate how it works in reference to a doctor’s description of her experience at a New Orleans’ hospital in the aftermath of Hurricane Katrina. Next, I proceed to define health and disease on the basis of Lonergan’s accounts of the human good, emergent probability and generalized empirical method. Then, I lay out the generic levels of human living in a table of terms whose interrelations embody the multiple dimensions of health and their dynamic potential for integration (and breakdown) in the GEM model of health.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"6 4","pages":"432-437"},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72476789","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}
Dmitry Khodyakov, B. Denger, S. Grant, K. Kinnett, Courtney Armstrong, Annalee Martin, H. Peay, I. Coulter, G. Hazlewood
Although clinical practice guidelines (CPGs) provide recommendations for how best to treat a typical patient with a given condition, patients and their representatives are not always engaged in CPG development. Despite the agreement that patient participation may improve the quality and utility of CPGs, there is no systematic, scalable method for engaging patients and their representatives, as well as no consensus on what exactly patients and their representatives should be asked to do during CPG development. To address these gaps, an interdisciplinary team of researchers, patient representatives, and clinicians developed the RAND/PPMD Patient-Centeredness Method (RPM) - a novel online approach to engaging patients and their representatives in CPG development. The RPM is an iterative approach that allows patients and their representatives to provide input by (1) generating ideas; (2) rating draft recommendations on two criteria (importance and acceptability); (3) explaining and discussing their ratings with other participants using online, asynchronous, anonymous, moderated discussion boards, and (4) revising their responses if needed. The RPM was designed to be consistent with the RAND/UCLA Appropriateness Method used by clinicians and researchers to develop CPG, while helping patients and their representative rate outcome importance and recommendation acceptability - two key components of the GRADE Evidence to Decision (EtD) framework. With slight modifications, the RPM has the potential to explore consensus among key stakeholders on other dimensions of the EtD, including feasibility, equity, and resource use.
{"title":"The RAND/PPMD Patient-Centeredness Method: a novel online approach to engaging patients and their representatives in guideline development.","authors":"Dmitry Khodyakov, B. Denger, S. Grant, K. Kinnett, Courtney Armstrong, Annalee Martin, H. Peay, I. Coulter, G. Hazlewood","doi":"10.5750/EJPCH.V7I3.1750","DOIUrl":"https://doi.org/10.5750/EJPCH.V7I3.1750","url":null,"abstract":"Although clinical practice guidelines (CPGs) provide recommendations for how best to treat a typical patient with a given condition, patients and their representatives are not always engaged in CPG development. Despite the agreement that patient participation may improve the quality and utility of CPGs, there is no systematic, scalable method for engaging patients and their representatives, as well as no consensus on what exactly patients and their representatives should be asked to do during CPG development. To address these gaps, an interdisciplinary team of researchers, patient representatives, and clinicians developed the RAND/PPMD Patient-Centeredness Method (RPM) - a novel online approach to engaging patients and their representatives in CPG development. The RPM is an iterative approach that allows patients and their representatives to provide input by (1) generating ideas; (2) rating draft recommendations on two criteria (importance and acceptability); (3) explaining and discussing their ratings with other participants using online, asynchronous, anonymous, moderated discussion boards, and (4) revising their responses if needed. The RPM was designed to be consistent with the RAND/UCLA Appropriateness Method used by clinicians and researchers to develop CPG, while helping patients and their representative rate outcome importance and recommendation acceptability - two key components of the GRADE Evidence to Decision (EtD) framework. With slight modifications, the RPM has the potential to explore consensus among key stakeholders on other dimensions of the EtD, including feasibility, equity, and resource use.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"64 1","pages":"470-475"},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90593657","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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