The realities of partnership in person-centred care: a qualitative interview study with patients and professionals

Abstract

ObjectiveAlthough conceptual definitions of person-centred care (PCC) vary, most models value the involvement of patients through patient-professional partnerships. While this may increase patients’ sense of responsibility and control, research is needed to further understand how this partnership is created and perceived. This study aims to explore the realities of partnership as perceived by patients and health professionals in everyday PCC practice.DesignQualitative study employing a thematic analysis of semistructured interviews with professionals and patients.SettingFour internal medicine wards and two primary care centres in western Sweden.Participants16 health professionals based at hospital wards or primary care centres delivering person-centred care, and 20 patients admitted to one of the hospital wards.ResultsOur findings identified both informal and formal aspects of partnership. Informal aspects, emerging during the interaction between healthcare professionals and patients, without any prior guidelines or regulations, incorporated proximity and receptiveness of professionals and building a close connection and confidence. This epitomised a caring, respectful relationship congruent across accounts. Formal aspects, including structured ways of sustaining partnership were experienced differently. Professionals described collaborating with patients to encourage participation, capture personal goals, plan and document care. However, although patients felt listened to and informed, they were content to ask questions and felt less involved in care planning, documentation or exploring lifeworld goals. They commonly perceived participation as informed discussion and agreement, deferring to professional knowledge and expertise in the presence of an empathetic and trusting relationship.ConclusionsIn our study, patients appear to value a process of human connectedness above and beyond formalised aspects of documenting agreed goals and care planning. PCC increases patients’ confidence in professionals who are competent and able to make them feel safe and secure. Informal elements of partnership provide the conditions for communication and cooperation on which formal relations of partnership can be constructed.

Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial

“…Other RCTs of gPCC have shown decreased re-hospitalisation and increased HRQoL [12], increased use of target doses of life-prolonging medication [25] and a significant cost reduction in patients with severe chronic heart failure [26]. gPCC emphasizes the patient's own resources which helps identifying reasonable goals during recovery [27], and facilitates both formal and informal partnership which patients perceive as a sense of ease and security [28]. From the perspective of health care professionals, gPCC introduces a new practice by facilitating active patient participation in decisions about their care, as well as creating a more person-centred approach toward improved inter-professional teamwork [29].…”

Simplifying the care plan documentation procedure – An interview study with nurses at a medical ward at a university hospital in Sweden

“…For example, Chevakasemsook et al [25] highlights that restrictions within medical records cause problems due to documentation of care plans with a humanistic perspective. Moreover, research [1,2,26] has shown that listening to patients facilitates joint agreement, which shortens the hospital stay and reduces costs by maintain continuity and partnership across professional boundaries. However, mutual care plans are described as tool of professional caregivers, not the patients.…”

Life situation among persons living with inflammatory bowel disease.

“…In line with the literature (103) , the results in this thesis show that by providing the right conditions for communication and mutual cooperation, a partnership can be created (II). The literature supports this finding and informal elements, such as emotionally supportive relationships, are important for ultimately determining the level of shared decision-making, paving the way for patients participations in care decisions (104,117).…”

“…Shared decision-making may be defined as the process of interaction with patients who wish to be involved in making decisions. The concept of shared decision-making entails that HC professionals have the responsibility to inform and recommend treatment to patients, but the process of deciding on how to act is shared (117). The goal is to enhance patient involvement and, on the basis of the available evidence, facilitate 'evidence-based patient choice'.…”

“…A partnership facilitates a care plan that patients are more likely to agree to and willing to follow (117).…”