Vagueness and variety in person-centred care

Abstract

Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a ‘clear definition and method of measurement,’ and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge caution about this concern and resist calls for a clear, settled definition and measurement approach. We develop a philosophical and conceptual analysis which is grounded in the body of literature concerning the theory and practice of person-centred care. We consider a range of influential definitional frameworks of person-centred care, highlighting their differences and showing that they do not correspond to a clearly circumscribed and consistent underlying concept. We argue that a degree of indeterminacy and vagueness should not be seen as a problem with the concept of person-centred care; these are features of a rich and contested concept which exists prior to and outside of practical and technical operational definitions and applications. We defend the value of operating with multiple accounts of person-centred care, arguing that what counts as being person-centred can vary across different care contexts, in relation to different patient groups, and as a reflection of different, defensible ethical perspectives. Although the idea of a single, agreed definition is attractive and may seem to be a practical or even necessary step towards meaningful and coordinated action, we argue that this is only the case in a qualified sense. Comprehensive attempts to narrow down the concept in this way should be resisted, as they risk undermining what it is that makes person-centredness a valuable concept in healthcare.

Unifying and universalizing Personalised Care? An analysis of a national curriculum with implications for policy and education relating to person-centred care

“…We approached the Curriculum with a working view of person-centredness as a concept rooted in the broad ideas of treating patients holistically and relating to people appropriately as humans or persons. We recognised that these are plural or multi-faceted ambitions and inevitably expressed in diverse ways [4,15]. We also brought an interest in the ethics of person-centred approaches, including concerns that some aspects of person-centredness may tend to pull away from others and detract from other important healthcare quality considerations [5,10,11,[15][16][17], and awareness that some efforts to promote person-centredness can perpetuate social disadvantage in healthcare [18][19][20].…”

“…Claims about conceptual unity are not essential to the advancement of Personalised Care or personcentred care. Personalised and person-centred care are plural and complex, and not just because they can be represented in several different models of practice [4,15]. Putting less emphasis on conceptual unity and more on the plurality of values that can matter for person-centredness within health and social care could ensure broader applicability and encourage recognition of some important value tensions and the skilful professional judgement involved in deploying combinations of values appropriate to diverse people and situations [4,5].…”

“…Exactly what this means and how it can be achieved remains open to debate -as does the question of whether any of several near-synonyms for person-centredness should be preferred. While there is ready agreement that person-centred approaches are not disease-centred, technology-centred or organised primarily for service providers' convenience, positive characterisations of person-centredness (and similar terms) draw on and variously emphasise several different ideas [1][2][3][4]. These include the importance of biopsychosocial assessment and more holistic engagement with patients (as a corrective to narrowly biomedical approaches) and various other forms of humanising, individualising or personalising healthcare, for example by tailoring treatments, and respecting and empowering patients as active agents [5][6][7][8].…”

“…Its flagship Curriculum [14] is intended to provide an "educational framework" to ensure that all healthcare practitioners learn "the essential elements" of personalised care(page 4). The Curriculum aspires to "unify the different ways of approaching Personalised Care" for all NHS staff with its specification of constituent elements, learning outcomes, and a framework for accreditation and governance(p. 4). An overview of the 80-page Curriculum is provided in Box 1.…”

Consultation skills development in general practice: findings from a qualitative study of newly recruited and more experienced clinical pharmacists during the COVID-19 pandemic

“…SMRs were required to be attentive to health literacy and conducted in line with the principles of shared decision-making by pharmacists who have, or are in training for, a prescribing qualification and have advanced assessment and history-taking skills. 17 Interchangeable use of the terms patient-centred and person-centred occurs within pharmacy, as in other healthcare professions, 18 with some preferring 'personcentred' because it connotes broader identities and social contexts than a recipient in a healthcare encounter. 19 'Health literacy' is another concept used in the SMR specification which invites multiple interpretations.…”