Keywords: person-centred care, patient-centered care, physician-patient communication, family-centered care
Health and social care systems, especially in the wake of the COVID-19 pandemic, are struggling to maintain the quality of care while containing health system costs. Person-centred care (PCC) has been proposed as a potential solution, and family-centered care (FCC) may be as well. Given the long-lasting relationships that primary care physicians often form with their patients and their patients' families, PCC/FCC may be naturally implemented in many consultations. However, there is a seemingly wide diversity both within and across primary care practices regarding PCC and FCC attitudes and behaviors. In addition to this variability, the impact of PCC/FCC implementation in primary care has not been adequately documented.
Therefore, the primary aims of this study is three-fold: (1) to examine attitudes concerning PCC/FCC as perceived by primary care staff, patients, and their family members; (2) to document the extent of PCC/FCC implementation in primary care consultations; (3) to measure the impact of PCC/FCC implementation on patient-reported outcomes, family-reported outcomes, physician-reported outcomes, patient health outcomes, and health system outcomes.
A longitudinal study involving quantitative and qualitative data collection will be conducted. Semi-structured and/or focus groups will be carried out with primary care staff, patients, and family members. The Person-centred Practice Inventory-Staff (PCPI-S) and Family Nurse Caring Belief Scale (FNBCS) will be completed by primary care staff, the Consultation and Relational Empathy (CARE) Measure by patients, and an adapted version of the CARE scale by family members. Questions to address FCC specifically for patients and family members will be identified based on relevant literature (in progress). If feasible, consultations will be video-recorded and coded for objective measurement of PCC/FCC or interactions observed and a checklist completed. Quantification of patient health outcomes given available EMR data and health system outcomes (e.g., cost savings) is currently in progress.
Points for discussion:
What are the indicators in the primary care consultation that person-centred care and/or family-centered care has occurred? What behaviors or written documentation could/should be measured?
How can the impact of person-centred care and/or family-centered care on health or health system outcomes be measured?
What is an appropriate follow-up time frame? What is the shortest time period in which impact on health or health systems outcomes could be documented?