Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
King's Global Health Institute, King's College London, London, UK.
BMJ Glob Health. 2022 Jul;7(7). doi: 10.1136/bmjgh-2022-008843.
Person-centred care (PCC) is internationally recognised as a critical component of high-quality healthcare. However, PCC evolved in a few high-income countries and there are limited data exploring this concept across the vast majority of countries which are low- and middle-income. This study aimed to appraise and adapt a PCC model across three serious physical conditions in three middle-income countries and generate an evidence-based framework and recommendations for globally relevant PCC.
Cross-national, cross-sectional qualitative study. In depth, semistructured interviews conducted with: advanced cancer patients in Jordan (n=50), their caregivers (n=20) and healthcare professionals (HCPs) (n=20); chronic obstructive pulmonary disease patients in South Africa (n=22), their caregivers (n=19) and HCPs (n=22); heart failure patients in Thailand (n=14), their caregivers (n=10) and HCPs (n=12). Data were analysed using framework analysis. Santana 's PCC model (2018) and Giusti 's systematic review (2020) were used to construct an a priori coding frame for deductive analysis, with additional inductive coding for coding that did not fit the frame.
The findings both reveal specific practical actions that contribute towards delivering PCC and highlight new cross-national domains of person-centredness: interdependency and collectivism; bringing care into the home and community; equity and non-discrimination; addressing health and illness within the context of limited resources; and workforce well-being.
The data suggest that PCC requires particular structural features of the healthcare system to be in place, such as professional education in PCC values and partnerships with community-based workers. These structures may better enable PCC processes, including tailored information sharing and providing genuine opportunities for patients to do the things that matter to them, such as making informed care decisions and sustaining social relationships. PCC must also accommodate a collectivist perspective and support the well-being of the workforce.
以患者为中心的护理（PCC）被国际公认为高质量医疗保健的重要组成部分。然而，PCC 是在少数几个高收入国家发展起来的，而在绝大多数中低收入国家，关于这一概念的研究数据有限。本研究旨在评估和调整三个中等收入国家的三种严重身体状况下的 PCC 模型，并生成一个具有全球相关性的基于证据的 PCC 框架和建议。
跨国、跨截面定性研究。在约旦对晚期癌症患者（n=50）、他们的照顾者（n=20）和医疗保健专业人员（HCPs）（n=20）；南非慢性阻塞性肺疾病患者（n=22）、他们的照顾者（n=19）和 HCPs（n=22）；泰国心力衰竭患者（n=14）、他们的照顾者（n=10）和 HCPs（n=12）进行了深入的半结构化访谈。使用框架分析法分析数据。使用 Santana 的 PCC 模型（2018 年）和 Giusti 的系统评价（2020 年）构建了一个演绎分析的先验编码框架，并对不符合框架的编码进行了额外的归纳编码。
研究结果既揭示了实现 PCC 的具体实际行动，又突出了新的跨国层面的以患者为中心：相互依存和集体主义；将护理带入家庭和社区；公平和非歧视；在资源有限的情况下解决健康和疾病问题；以及劳动力福利。
数据表明，PCC 需要医疗保健系统具备特定的结构特征，例如 PCC 价值观的专业教育和与社区为基础的工作者建立伙伴关系。这些结构可能更好地促进 PCC 过程，包括量身定制的信息共享和为患者提供真正的机会，让他们做对他们重要的事情，如做出明智的护理决策和维持社会关系。PCC 还必须适应集体主义观点并支持劳动力的福利。
