Shifting roles: physiotherapists’ perception of person-centered care during a pre-implementation phase in the acute hospital setting - A phenomenographic study

Abstract

Background: Person-centered care (PCC) is an acknowledged health care practice involving increased patient influence regarding decisions and deliberation. Research indicates that physiotherapists (PTs) embrace patient participation, but that PCC is difficult to grasp and fully implement. Objective: To contribute to knowledge about how PCC influences physiotherapy by eliciting PTs' experiences from the acute care setting, this study aims to describe and illuminate variations in perceptions of PCC during a pre-implementation phase, among PTs in acute hospital care. Methods: Phenomenological approach: individual interviews with PTs in acute care (n = 7) combined with focus group interviews (n = 3). Findings: The analysis yielded two main categories: 1) Physiotherapists perceived a transformed patient role involved in the transition from patient to person; and 2) Physiotherapists perceived a challenged professional role when departing from the expert role, and entailed restrictions to prescribing the best treatment and, instead, meant aiming for a collaborative and equal relationship with the patient. Conclusion: Although the interviewed PTs embraced PCC in principle, PCC does seem to challenge the professional roles of patient and PT. The findings indicate that theories of power relations need to be considered, and further reflection may facilitate implementation. More research is needed to deepen the knowledge of how PTs perceive PCC during all implementation phases.

Person-centred care in individuals with stroke: a qualitative study using in-depth interviews

“…Previous studies have shown that during rehabilitation, it is necessary to identify life goals and interventions [ 4 ], understanding which ones are meaningful to the individual [ 48 ]. This would enable the establishment of person-centred goals in a collaborative and egalitarian manner, moving away from pre-established roles [ 13 ] and respecting the individual's limits [ 56 ]. The fact that the person is the protagonist of their intervention generates empowerment and improves the meaning of life when they feel supported in the goals that they themselves have defined [ 7 , 49 ].…”

“…The PCC model includes biomedical variables in care, and the individual's wishes and values in relation to their clinical situation to achieve a better understanding of the effect of treatment and care on the person, their family and environment [ 7 ]. In its application, the role of the healthcare professional is essential, because it requires a change in their professional role and their relationship with individuals [ 13 ] that can directly influence the development of PCC [ 14 ].…”

Teaching person-centred practice in physiotherapy curricula: a literature review

“…Finally, this study found that the educational interventions challenged student's assumptions, expectations, preconceived ideas, and prejudices they held towards patients and person-centred physiotherapy practice [18,21,22,25,27]. It is not surprising that the students faced challenges in their views of person-centred practice as these challenges are similarly felt by qualified practitioners who theoretically embrace the principles but can struggle to implement them in clinical practice [15]. Some of the challenges faced by students related to the biomedical philosophy they developed in the early stages of their learning [18,27].…”

“…This biomedical viewpoint can limit the ability of the physiotherapist to manage key aspects of person-centred practice such as building a positive therapeutic relationship, the valuing of patient preferences, managing expectations, and fostering a sense of hope [13]. Thus, in principle, physiotherapists embrace person-centred practice, however, they can struggle to implement it clinically [15].…”

‘Getting them on board’: Musculoskeletal physiotherapists conceptions of management of persons with low back pain

“…A person‐centred approach which places the individual at the centre of their care, validating them and gaining an insight into their goals and expectations has been advocated (O'Sullivan, Caneiro, O'Keeffe, & O'Sullivan, 2016). Physiotherapists have traditionally received a biomedical approach to their training (Pincus et al, 2007) and although physiotherapy education now takes a BPS approach, a recent phenomenographic study found that physiotherapists perceived that the power shift in decision making with a person centred approach challenged their professional (Sjöberg & Forsner, 2020). Furthermore, some physiotherapists find operationalising multidimensional management challenging, highlighting the barriers to integrating a psychosocial assessment into regular practice (Singla, Jones, Edwards, & Kumar, 2015).…”