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Samenvatting Patient Centered Care Delivery (GW4002)
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Samenvatting van het vak Patient Centered care op basis van alle literatuur en colleges
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PCCD – Patient Centered Care Delivery – 2022/2023 – SUMSummary theme 1
Patient Centered Care (PCC) – ‘therapeutic alliance’ – a concept focussed on the individual patient as
decision maker within their own care process, given that they know best what they experience and
what they need. In such care is based on patient-specific information (understanding the patient),
informing the patient and respond to the patient’s needs and preferences. The concept is often
explicated through the 8 dimensions of PCC (Rathert et al.)
The 8 dimensions:
1. Respect for patient preferences: getting to know the patient and their preferences and in
such deciding on treatment plant together (SDM)
2. Information, education and communication: Patients know best what their health condition
means to them, therefore we have to provide patients with the right information regarding
their disease, different treatment plans etc. In order for them to make the best decision for
them.
3. Physical comfort: not only in everyday life, but also when attending a healthcare facility,
caregivers must take into account the support needs. E.G., nice chairs, a clean environment
4. Emotional support: often, in the light of a disease, there are social and mental challenges in
place.
5. Involvement of family: depending on severity of the disease, often family is affected as well.
This could be through informal caregiving, but also because they could use some emotional
support themselves regarding the disease of a loved one.
6. Access to care: think about practicalities such as financial access, the ability to make an
appointment or use a webportal etc., ability to schedule a procedure on time or the
accessibility to a building.
7. Coordination of care: the planning of care, when does one need which form of care and
where. Is this organized in such a way that it’s easy for the patient to navigate through the
system/is the patient not send everywhere and getting nowhere?
8. Continuity & Transition: how different caregivers organize and share what they’ve done for a
patient in order for all caregivers to be up-to-date on the disease, treatment and history of a
patient.
EMB – following the current best evidence (scientific) in making decisions about the care of patients.
– ‘little inconsistency among definitions – the conscientious, explicit, and judicious use of current best
evidence in making decisions.’
EBPCC – the integration of PCC and EMB – a framework of information management, built on the
needs of patients rather than the availability of evidence
Patient-centered medical home – a concept widely promoted as the basis for primary care reform.
The principle states that they include the voices of patients in decision making, accounting for all the
care needs of a patient; coordinated across all of the patient’s touchpoints within the healthcare
system. Intended to improve quality, efficiency, and patient experience of care – e.g., enhanced
access for routine primary care, improved delivery of preventative services, high-quality chronic
disease management, and reduced emergency department and hospital utilization
, Summary theme 2
Medical decision making – Shared Decision-Making
Paternalistic model – it’s a clinician-patient relationship in which the clinician is the primary
decisionmaker, due to his knowledge and skill.
Autonomy model – recognizes the right of patients to make their own informed decisions in relation
to their treatment.
Shared decision-making (SDM): concerns the interaction between patient and healthcare provider,
which should be a bidirectional exchange of information and preferences. It focusses on the
autonomy of the patient in the light of medical decisions, while also taking into consideration the
necessary contribution of the physician due to his/her expertise (knowledge and skills) in the decision
making process. The importance of the use of the concept often arises in case of uncertainty about
which decision is best – the decision for a given patient often depends on that given patient’s
preferences and attitudes towards outcomes.
Patients receive information on the available treatment options, evaluate these options
(together with the clinician) in the light of their own circumstances, goals and preferences
and then select the best course of action.
SDM could improve outcomes by increasing patients’ involvement in medical decision-
making and in such their understanding, trust and adherence to treatment plans
Uncertainty
preference sensitivity; following the scientific research there is no best option.
Lack of or conflicting scientific evidence; the literature offers no definitive conclusion.
Due to the level of individual decisions; probabilities of an entire population can’t be directly
translated to an individual.
Every decision comes with its own set of consequences, and because different patients place
different values on each of these consequences the choice of treatment depends on the
preferences/values of the given patient. Therefore patients need to be involved in those
medical decisions.
Patient autonomy – ‘the right of patients to make decisions about their medical care without
experiencing undue influence from their health care providers.’
Relational autonomy – by informing the patient on their health status, consequences of treatment
plans and helping them align their choices with their values. The clinician enables the patient to make
decisions – well-informed decisions – concerning their health.
Why SDM?
Following research, SDM attributes to health outcomes >> patients who actively participate in their
own medical decision making tend to have better outcomes than those who don’t.
Every decision comes with its own consequences and considering that all patients are
different and value different outcomes, the choice of treatment depends as much on
patient’s values and preferences (with regards to the different consequences) as it does on
correct diagnosis and expertise.
‘The patient’s job is to think about what is most important personally, given some
understanding of their medical condition and how that condition is likely to evolve over time,
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