Greenfield Geva, Ignatowicz Agnieszka M, Belsi Athina, Pappas Yannis, Car Josip, Majeed Azeem, Harris Matthew
BMC Health Serv Res. 2014 Nov 29;14:619. doi: 10.1186/s12913-014-0619-9.
Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient's world. Patient-centeredness has been commonly defined through physician's behaviors aimed at delivering patient-centered care. Yet, it is unclear how 'person-centeredness' is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.
We conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant comparison.
We identified six themes representing core 'ingredients' of person-centeredness in the integrated care context: "Holism", "Naming", "Heed", "Compassion", "Continuity of care", and "Agency and Empowerment", all depicting patient expectations and assumptions on doctor and patient roles in integrated care. We bring examples showing that when these needs are met, patient experience of care is at its best. Yet many patients felt 'unseen' by their providers and the healthcare system. We describe how these six themes can portray a continuum between having own physical and emotional 'Space' to be 'seen' and heard vs. feeling 'translucent', 'unseen', and unheard. These two conflicting experiences raise questions about current typologies of the patient-physician relationship as a 'dyad', the meanings patients attributed to 'care', and the theoretical correspondence between 'person-centeredness' and 'integrated care'.
Person-centeredness is a crucial issue for patients in integrated care, yet it was variably achieved in the current pilot. Patients in the context of integrated care, as in other contexts, strive to have their own unique physical and emotional 'space' to be 'seen' and heard. Integrated care models can benefit from incorporating person-centeredness as a core element.
以患者为中心的护理强调一种整体的、人文主义的方法，将患者置于首位，使其成为医疗护理的核心。以患者为中心也被视为综合护理的核心要素。然而，综合护理的类型学主要描述患者如何融入综合服务，而非服务如何融入患者的世界。以患者为中心通常是通过医生旨在提供以患者为中心护理的行为来定义的。然而，目前尚不清楚在综合护理中如何通过患者的声音来实现“以患者为中心”。我们旨在探索综合护理背景下患者对以患者为中心的叙述。
我们进行了一项现象学定性研究，包括对伦敦西北部综合护理试点项目中登记的22名患者进行半结构化访谈。我们纳入了扎根理论方法的原则，包括实质性开放式编码和选择性编码、概念和类别的发展以及持续比较。
我们确定了六个主题，代表综合护理背景下以患者为中心的核心“要素”：“整体性”、“命名”、“关注”、“同情”、“护理连续性”以及“能动性与赋权”，所有这些都描绘了患者对综合护理中医生和患者角色的期望和假设。我们给出的例子表明，当这些需求得到满足时，患者的护理体验最佳。然而，许多患者感觉他们未被提供者和医疗系统“看见”。我们描述了这六个主题如何描绘出一种连续体，即从拥有自己的身体和情感“空间”以被“看见”和倾听，到感觉“透明”、“未被看见”和未被倾听。这两种相互冲突的体验引发了关于当前医患关系作为“二元组”的类型学、患者赋予“护理”的意义以及“以患者为中心”与“综合护理”之间理论对应关系的问题。
以患者为中心是综合护理中患者的一个关键问题，但在当前试点中其实现情况各不相同。与其他情况一样，综合护理背景下的患者努力拥有自己独特的身体和情感“空间”以被“看见”和倾听。综合护理模式可受益于将以患者为中心纳入核心要素。
