Placing People’s Preferences at the Heart of Health Care
Wednesday, December 2, 2015
When your healthcare professionals focus on putting you at the center of your healthcare plan by responding to outcomes and preferences that are important to you and your family, they are practicing person-centered care. “But for too long, our medical system has focused on treatment of illnesses rather than on care of a person with illnesses,” explained Laura Mosqueda, MD, FAAFP, AGSF, Chair, Department of Family Medicine, Professor of Family Medicine and Gerontology, Keck School of Medicine of USC. This may be because, up until now, no standard definition for person-centered care for older adults and what it entails has existed.
Recently, the American Geriatrics Society (AGS) brought together an expert panel to develop a definition of person-centered care for older adults and a list of its essential elements. The panel included experts from various healthcare sectors and professions. They collaborated with a research and clinical team from the University of South California, including Dr. Mosqueda, who served as Principal Investigator. The SCAN Foundation, which funds work to advance high-quality healthcare services for older adults, supported the project.
The AGS-organized expert panel evaluated research conducted by Dr. Mosqueda and colleagues from USC—Alexis Coulourides Kogan, PhD, and Kathleen Wilber, PhD. This work included a review of studies already conducted on person-centered care, as well as opportunities to talk with leaders from healthcare and social service organizations that said they were already providing person-centered care for older adults. They found that organizations often define person-centered care in unique ways, but that all of them remain committed to how valuable the approach can be, and to certain core features that make it unique. Following an extensive process of review and discussion, the panel defined person-centered care for older adults as gathering specific information about a person’s preferences in light of his or her health, with input from family members and other caregivers if the person desires. According to the expert panel, several essential characteristics define this type of an approach to health care:
- An individualized, goal-oriented care plan based on a person’s expressed preferences.
- An on-going review of a person’s goals and care plan (including opportunities to reassess the plan regularly to address health status changes over time).
- Care supported by a team of healthcare providers with different kinds of expertise, but including the person as a team member, too.
- One primary contact person on the healthcare team who is responsible for communicating information and coordinating care with the person and all the other team members.
- Continual information sharing and communication between the person, family, and all healthcare and supportive service providers.
- Education and training about person-centered care for providers and, when appropriate, for the person and his/her family or loved ones.
- Ways to assess whether the person’s preferences and needs are being met, and to make changes as needed based on feedback from the person and his or her caregivers.
The expert panel also identified several barriers to the practice of person-centered care. These include:
- Traditional approaches to clinical practice, in which healthcare providers function as principal decision makers for their patients. Making a person part of the healthcare team goes a long way toward making positive change in this regard.
- The workload that many healthcare professionals often face. Doctors, nurses, and other healthcare providers often have heavy demands and time constraints. Well-coordinated healthcare teams can help distribute the workload and also can contribute a variety of skills to delivering person-centered care.
- Identifying appropriate indicators of health and well-being. Focusing on quality of life and easing symptoms should be higher priorities than attaining specific treatment outcomes or standards that may not reflect what a person wants from care.
- Lack of advance care planning. Many people, especially those with dementia, have never discussed their care desires, leaving their loved ones to do their best to decide what they would have wanted. Making these conversations a part of regular practice is an important element of a person-centered approach.
This summary is from “Person-Centered Care: A Definition and Essential Elements.” It appears online ahead of print in the January 2015 issue of the Journal of the American Geriatrics Society.