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Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review.

ABSTRACT: Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results: The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned. Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources. This distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.

SUBMITTER: Tomaselli G

PROVIDER: S-EPMC7067745 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review.

Tomaselli Gianpaolo G Buttigieg Sandra C SC Rosano Aldo A Cassar Maria M Grima George G

Frontiers in public health 20200306

<b>Background:</b> The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety ...[more]

PMID: 32211362

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Project description:IntroductionSensory-processing sensitivity (SPS) refers to interindividual differences in sensitivity to positive and negative environmental stimuli and reflects the concept of differential susceptibility. The Highly Sensitive Person Scale (HSPS) has been utilized to capture the multifaceted experiences of highly sensitive individuals. The scale's total score (i.e., the sum of the subfactors) is an indicator of high sensitivity. However, it cannot differentiate between the contributions of the specific subfactors. Consequently, interpreting the total score cannot help resolve the current theoretical debate about how individuals integrate the positive and negative aspects of sensitivity, whereas a multidimensional profile should be able to offer a more comprehensive understanding. Intriguingly, in variable-centered research, the subfactors' differential associations with external constructs in negative or positive trait spaces have suggested heterogeneity (i.e., interindividual differences) among highly sensitive individuals. Thus, person-centered approaches should be better suited to address this heterogeneity.MethodsTo explore heterogeneity within the highly sensitive population, we conducted a three-step Latent Profile Analysis in two independent German-speaking samples (N = 1,102; N = 526). Subsequently, we employed the Five-Factor Model of personality to provide a detailed description of the latent sensitivity groups.ResultsBeyond the frequently identified quantitative three-class differentiation of sensitivity groups, we obtained a four-class model that included two qualitatively different high-sensitivity groups, each displaying distinct HSPS subfactor and personality patterns that corresponded to prototypical personality profiles. Within these high sensitivity groups, (i) the Confident Sensitivity Group exhibited average Neuroticism, significantly above-average Openness, and slightly above-average Extraversion. By contrast, (ii) the Vulnerable Sensitivity Group displayed the typical personality pattern of significantly above-average Neuroticism, below-average Extraversion, and slightly above-average Openness. Personality analyses revealed that features such as passiveness, internalizing tendencies, giftedness, and aesthetics, often commonly ascribed to all highly sensitive individuals, are features that differ across distinct sensitivity groups.DiscussionTo avoid over- or underestimating sensitivity effects, future research should consider these interindividual differences in highly sensitive individuals. For instance, studies could focus on the different associations of sensitivity groups with abilities, health aspects, emotion regulation and intervention outcomes, taking into account the different environmental factors that shape the type of sensitivity.

Project description:Background: Delivering person-centered care is one of the core values in general practice. Due to the complexity and multifaceted character of person-centered care, the effects of person-centered care cannot be easily underpinned with robust scientific evidence. In this scoping review we provide an overview of research on effects of person-centered care, exploring the concepts and definitions used, the type of interventions studied, the selected outcome measures, and its strengths and limitations. Methods: Systematic reviews on person-centered care compared to usual care were included from Pubmed, Embase, and PsycINFO. The search was conducted in February 2021. Data selection and charting was done by two reviewers. Results: The literature search yielded 481 articles. A total of 21 full-text articles were assessed for eligibility for inclusion. Four systematic reviews, published between 2012 and 2018, were finally included in this review. All reviews used different definitions and models and classified the interventions differently. The explicit distinction between interventions for providers and patients was made in two systematic reviews. The classification of outcomes also showed large differences, except patient satisfaction that was shared. All reviews described the results narratively. One review also pooled the results on some outcome measures. Most studies included in the reviews showed positive effects, in particular on process outcomes. Mixed results were found on patient satisfaction and clinical or health outcomes. All review authors acknowledged limitations due to lack of uniform definitions, and heterogeneity of interventions and outcomes measures. Discussion: Person-centered care is a concept that seems obvious and understandable in real life but is complex to operationalize in research. This scoping review reinforces the need to use mixed qualitative and quantitative methods in general practice research. For spreading and scaling up person-centered care, an implementation or complexity science approach could be used. Research could be personalized by defining therapeutic goals, interventions, and outcome variables based on individual preferences, goals, and values and not only on clinical and biological characteristics. Observational data and patient satisfaction surveys could be used to support quality improvement. Integrating research, education, and practice could strengthen the profession, building on the fundament of shared core values.

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Project description:BackgroundWhile family caregivers provide 70-90% of care for people living in the community and assist with 10-30% of the care in congregate living, most healthcare providers do not meaningfully involve family caregivers as partners in care. Recent research recommends that the healthcare workforce receive competency-based education to identify, assess, support, and partner with family caregivers across the care trajectory.ObjectiveThis paper reports a mixed-methods evaluation of a person-centered competency-based education program on Caregiver-Centered Care for the healthcare workforce.MethodsThis foundational education was designed for all healthcare providers and trainees who work with family caregivers and is offered free online (caregivercare.ca). Healthcare providers from five healthcare settings (primary, acute, home, supportive living, long-term care) and trainees in medicine, nursing, and allied health were recruited via email and social media. We used the Kirkpatrick-Barr health workforce training evaluation framework to evaluate the education program, measuring various healthcare providers' learner satisfaction with the content (Level 1), pre-post changes in knowledge and confidence when working with family caregivers (Level 2), and changes in behaviors in practice (Level 3).ResultsParticipants were primarily healthcare employees (68.9%) and trainees (21.7%) and represented 5 healthcare settings. Evaluation of the first 161 learners completing the program indicated that on a 5-point Likert scale, the majority were satisfied with the overall quality of the education (Mean(M) = 4.69; SD = .60). Paired T-tests indicated that out of a score of 50, post-education changes in knowledge and confidence to work with family caregivers was significantly higher than pre-education scores (pre M = 38.90, SD = 6.90; post M = 46.60, SD = 4.10; t(150) = - 16.75, p < .0001). Qualitative results derived from open responses echoed the quantitative findings in satisfaction with the education delivery as well as improvements in learners' knowledge and confidence.ConclusionHealth workforce education to provide person-centered care to all family caregivers is an innovative approach to addressing the current inconsistent system of supports for family caregivers. The education program evaluated here was effective at increasing self-reported knowledge and confidence to work with family caregivers.

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Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review.

Publications

Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review.

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