Patient-centeredness in the multimorbid elderly: a focus group study

Abstract

Background Patient-centeredness (PC) aims to adapt health care to the individual needs and preferences of patients. An existing integrative model of PC comprises several dimensions of PC which have not yet been investigated from the patients’ perspective. Older patients with multimorbidity represent a target group for patient-centered care, as their care needs are particularly complex and should be addressed individually. We aimed to assess the perspective that older patients with multimorbidity have of patient-centered care and to examine the transferability of the integrative model of PC to this specific population. Method We performed 4 guided focus group interviews with a total of 20 older individuals with multimorbidity. The focus group interviews were audio-recorded and transcribed verbatim. Patients’ statements were content-analyzed applying an a priori designed system of categories that included the dimensions of PC from the integrative model and the additional category ‘prognosis and life expectancy’, which had emerged from an initial literature search on aspects of PC specific to the multimorbid elderly. Results The new category ‘prognosis and life expectancy’ was confirmed and expanded to ‘individual care needs related to aging and chronic disesase’. All dimensions of our integrative PC model were confirmed for older patients with multimorbidity. Among these, we found that eight dimensions (individual care needs related to aging and chronic disease, biopsychosocial perspective, clinician-patient communication, essential characteristics of the clinician, clinician-patient-relationship, involvement of family and friends, coordination and continuity of care, access to care) were complemented by aspects specific to this target population. Conclusions The integrative PC model is applicable to the population of older patients with multimorbidity. For a population-specific adaptation, it might be complemented by the dimension ‘individual care needs in aging and chronic disease’, in conjunction with age-specific aspects within existing dimensions. Together with corresponding results from a Delphi survey, our adapted PC model will serve as the basis for a subsequent systematic review of instruments measuring PC in older patients with multimorbidity. Trial registration PROSPERO (https://www.crd.york.ac.uk/prospero; CRD42018084057; 2018/02/01), German Clinical Trials Register (www.drks.de; DRKS00013309; 2018/01/23).

Interprofessionelle Teambildung – ein hochschulübergreifendes Qualifizierungsprogramm

“…Das bedeutet, dass klassische Rollenzuweisungen in der geriatrischen Versorgungsrealität künftig deutlicher hinterfragt werden und – damit einhergehend – Zuständigkeiten weniger starr festgeschrieben sein müssen. Dieser Aspekt wird durch aktuelle Studien weiter untermauert, da in geriatrischen Versorgungskontexten alte Menschen ihre zunehmende psychophysische Vulnerabilität mit Blick auf Einsamkeit, steigende Symptomlast, Gebrechlichkeit und den damit verbundenen Autonomieverlust wahrgenommen und von Professionellen adressiert wissen wollen [ 10 ].…”

“…Diese Weitung des Teamverständnisses auch auf Berufsgruppen, die im geriatrischen Setting zusätzlich die für alte Menschen besonders wichtige soziale Perspektive einbringen, ist neu. Und das ist auch das innovative Moment im hier vorgestellten Modul „Der geriatrische Patient“, weil damit auch ein sektorenübergreifendes Denken und Handeln angeregt wird, das in der Realität der Praxis dringend gebraucht wird, wie dies auch in jüngsten Arbeiten bestätigt werden konnte [ 10 ].…”

Hospital Culture and Healthcare Workers' Provision of Patient-Centered Care: A Moderated Mediation Analysis

“…Gender, grade, empathy, and communication skills were found to have statistically significant effects on dental students' attitudes regarding patient-centered services, which could be improved via a focus on enhancing empathy, emphasizing positive attitudes toward learning communication skills, and conducting patient-centered learning seminars ( 9 ). Furthermore, Kanat et al ( 10 ) found that the doctor-patient relationship and communication, doctors' characteristics, and patients' engagement were important determinants of PCC. Paiva et al ( 11 ) investigated the factors facilitating and inhibiting healthcare workers' implementation of PCC; they contended that the creation of an atmosphere that is conducive to communication, engagement of patients in medical decisions, and enhancement of medical personnel's ability to communicate effectively might foster the provision of PCC by medical workers.…”

“…Studies have linked PCC with various positive patient outcomes, including empowerment and engagement ( 10 , 12 ) favorable health outcomes, diminished socioeconomic, and racial disparities, shorter hospitalization periods and earlier discharge, and lower treatment costs ( 13 , 14 ). However, the existing literature on PCC has the following drawbacks.…”

“…In addition, we included self-efficacy as an essential factor in the proposed model as this—as another intrinsic variable—could reflect healthcare personnel's level of confidence in the provision of PCC ( 26 ). Self-efficacy is an individual's belief in their capacity to set and achieve certain goals, that is, confidence in one's abilities ( 10 ). It is important to note that self-efficacy affects people's mindsets, responsiveness to emotions, and choice of behaviors ( 27 ).…”