Person‐centred care dialectics—Inquired in the context of palliative care

Abstract

Although a widely used concept in health care, person-centred care remains somewhat ambiguous. In the field of palliative care, person-centred care is considered a historically distinct ideal and yet there continues to be a dearth of conceptual clarity. Person-centred care is also challenged by the pull of standardization that characterizes much of health service delivery. The conceptual ambiguity becomes especially problematic in contemporary pluralistic societies, particularly in the light of continued inequities in healthcare access and disparities in health outcomes. Our aim was to explicate premises and underlying assumptions regarding person-centred care in the context of palliative care with an attempt to bridge the apparently competing agendas of individualization versus standardization, and individuals versus populations. By positioning person-centredness in relation to the hermeneutics of the self according to Paul Ricœur, dialectics between individualization and standardization, and between individuals and populations were constructed. The competing agendas were related in a dialectic manner in the way that population health is of importance for the individual, and standardization is of importance for the population. The analysis suggests that person-centred care is an ethical stance, which gives prominence to both suffering and capability of the individual as a person. The dialectic analysis points towards the importance of extending person-centred care to encompass population and societal perspectives and thereby avoiding a problematic tendency of affiliating person-centred care with exclusively individualistic perspectives. Considerations for person-centred palliative care on micro-, meso- and macrolevels conclude the paper.

Patients’ experiences of using the Integrated Palliative care Outcome Scale for a person‐centered care: A qualitative study in the specialized palliative home‐care context

“…Leplege et al () point out that person‐centered care means acknowledging that patients’ needs are evolving, and interventions therefore need to be individually tailored. Öhlén et al, ) argue that both standardization and individualization of person‐centered care are necessary for patients’ narratives and experiences to be heard. As McClimans () suggests, one way of individualizing the use of standardized PROMs is to use them as a way to enhance communication with patients.…”

“…Rushton and Edvardsson () argue that I‐Thou relationships denote person‐centeredness and can develop in health care through the use of patients’ narratives of their experience of illness in the care process. Using standardized assessment instruments, such as IPOS, when communicating with patients can enable person‐centered communication by facilitating the patient's narrative (Öhlén et al, ).…”

“…In person‐centered palliative care, patients’ experiences and quality of life should be assessed. Nurses possess the ability to enable patients to share their stories by adopting structured communication, stressing the importance of using patient‐reported outcome measures (PROMs) (Öhlén et al, ).…”

“…The idea of person‐centeredness has influenced many different branches of health care (Leplege et al, ). Essential in person‐centered care is that patient's quality of life and experiences are acknowledged and routinely assessed by enabling patients’ narratives (Öhlén et al, ). This tenet is also acknowledged in palliative care and highly valued within the field.…”

“…However, despite health care professionals’ intention to engage in discussions with patients about important issues, their view of what constitutes an important issue may well differ from that of the patients, which could result in certain topics not being raised. This could be prevented by fostering structured dialogues by using PROMs (Öhlén et al, ).…”