Lorenz Laura S, Chilingerian Jon A
Institute for Behavioral Health, Brandeis University, USA.
J Vis Exp. 2011 Feb 16(48):2342. doi: 10.3791/2342.
The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.
医学研究所已将以患者为中心作为质量改进的一个重要领域。以患者为中心的一个主要方面是尊重患者的价值观、偏好和表达的需求。然而，在临床环境中，缺乏获得这种理解并将其转化为优质护理的具体方法。从患者的角度来看，质量不是一个简单的概念，最好从五个维度来理解：技术结果；决策效率；便利设施和便利性；信息和情感支持；以及患者总体满意度。如果不从这五个方面的角度来考虑质量，就会只关注医疗结果，而不考虑从患者角度来看对质量至关重要且对实现良好结果至关重要的过程。在本文中，我们主张在临床环境中应用公平过程的概念。公平过程包括采用协作方法与患者探讨诊断问题和治疗方法，解释决策的理由，设定关于角色和责任的期望，并实施核心计划和持续评估。公平过程为将患者的专业知识引入临床环境以及制定医疗保健目标和策略的工作打开了大门。本文逐步说明了一种创新的视觉方法，称为照片声音法或照片启发法，以在与获得性脑损伤幸存者及其他患有慢性健康状况的患者的临床工作中实现公平过程。在临床环境中应用这种视觉工具和方法将加强医患沟通；让患者作为合作伙伴参与识别挑战、优势、目标和策略；并支持对一段时间内进展情况的评估。要求患者将他们生活的视觉资料带入临床互动中，有助于揭示临床知识方面的差距，与患有脑损伤等慢性疾病的患者建立更好的治疗关系，并确定以患者为中心的目标和康复可能性。这里所说明的过程可供与患有获得性脑损伤、精神疾病、身体残疾、艾滋病毒/艾滋病、药物滥用或创伤后应激等慢性疾病的患者一起工作的临床医生（初级保健医生、康复治疗师、神经科医生、神经心理学家、心理学家等），以及上述类型患者的支持小组负责人及其家庭成员或护理人员使用。
