What Is Patient-Centered Care Really? Voices of Hispanic Prenatal Patients

Abstract

Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling.

Differences that matter: developing critical insights into discourses of patient-centeredness

“…Bergman and Connaughton (2013) argue, for example, that the healthcare professional’s sensitivity to communication preferences can be critical to whether patients perceive an encounter as patient-centered. In a similar vein, De Haes (2006) suggests that the effectiveness of the physicians’ communication may depend on the person in front of them.…”

“…As an illustration of the former, Bergman and Connaughton (2013) have related the importance of responsiveness to the challenge of cultural diversity. On the basis of a study of the preferences of Hispanic prenatal care patients, they argue that patient-centeredness requires cultural sensitivity:

Sometimes referred to as cross-cultural differences, divisions in sociocultural patterns often produce dilemmas between medical experts and patients […].

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“…These challenges may relate to differences in communication styles or spiritual beliefs, as well as the role that hierarchy and respect play in active participation in doctor– patient interactions […] Each patient and provider comes to the health care encounter with his/her own beliefs and expectations guided by a particular culture of health. […] A worthwhile goal would be to avoid defining and implementing patient centered communications as a one-size-fits-all approach (Bergman and Connaughton 2013, p. 791 and 797)In a similar vein, Jayadevappa and Chhatre (2011) argue that cultural competence needs to be factored into patient-centered care. Among other things, understanding the meaning of culture can help healthcare professionals to understand and be responsive to patient beliefs, preferences and needs, and consequently, to build rapport and trust.…”

“…These challenges may relate to differences in communication styles or spiritual beliefs, as well as the role that hierarchy and respect play in active participation in doctor– patient interactions […] Each patient and provider comes to the health care encounter with his/her own beliefs and expectations guided by a particular culture of health. […] A worthwhile goal would be to avoid defining and implementing patient centered communications as a one-size-fits-all approach (Bergman and Connaughton 2013, p. 791 and 797)…”

Feasibility and Validation of Real-Time Patient Evaluations of Internal Medicine Interns' Communication and Professionalism Skills

“…Narrative patient feedback may explore what patients view as important in communication and professionalism. 31,32 Conclusion A 16-item patient evaluation assessing interns' communication and professionalism skills, and team communication was developed. A large number of evaluations are required to provide a reliable patient assessment of trainee communication skills, and this may be prohibitive for the implementation of such evaluations during training.…”