Reflecting on patient-centred care in pharmacy through an illness narrative

Seeing the Elephant: A Systematic Scoping Review and Comparison of Patient-Centeredness Conceptualizations from Three Seminal Perspectives

“Patient-Centeredness” (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC’s stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct’s operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.

Patient-Centered Care preferences & expectations in outpatient pharmacist practice: A three archetype heuristic

BACKGROUND

Patient-Centered Care (PCC) resides in the center of the Joint Commission of Pharmacy Practitioners' "Pharmacists' Patient Care Process" (PPCP) and is essential to successful management of chronic disease. However, the widely recognized importance and relevance of PCC contrasts with the limited number of studies in the pharmacist literature investigating patient preferences and expectations that inform PCC. Filling this gap is vital for improving pharmacist PCC at the micro-level (i.e., within and adjacent to patient-pharmacist encounters), meso-level (i.e., healthcare systems), and macro-level (i.e., legislation, payment, workforce dynamics).

OBJECTIVE

The study's objective was to describe, interpret, and compare patient preferences and expectations of Patient-Centeredness in pharmacist outpatient care.

METHODS

This mixed methods study used semi-structured, in-depth phone interviews among a purposive national sample of US adult patients with multiple chronic conditions and the experienced outpatient pharmacists caring for them. Interviews aimed to elicit conceptual definitions and concrete experiences of Patient-Centeredness in pharmacist care, were analyzed following Bengtsson's Content Analysis procedures, and assessed for reliability using Perrault and Leigh's Reliability Index. Data trustworthiness was interpreted using processes outlined by Guba & Krefting.

RESULTS

Data analysis revealed a three-archetype heuristic of preferences and expectations for pharmacist care: 'Partner,' 'Client,' and 'Customer.' Each respective archetype is described and distinguished from the others across five common factors: Nature of the Relationship & Locus of Control; Care Customization; Encounter Duration & Care Longevity; Intent of Communication; and Source of Value. Exemplar excerpts from study participants also illuminate the meaning and distinctiveness of each respective archetype across the five factors.

CONCLUSIONS

Findings suggest a novel approach for exploring pharmacist PCC quality, design, evaluation, and value-based payment at the micro-, meso-, and macro-levels of care. Future research should include operational field testing to investigate the model's validity, applicability, and consistency in pharmacist PCC.

Preparing pharmacy students to communicate effectively with adolescents

OBJECTIVES

To develop an elective workshop designed to equip pharmacy students with skills to effectively communicate with adolescents. To conduct preliminary evaluation of the workshop to assess its impact on pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

METHODS

Academics from three universities in three countries collaborated on the workshop development and evaluation. The workshop structure was designed upon the foundations of communication best practices and established techniques, and it consisted of two online modules and an in-person tutorial. Pharmacy students undertaking a 4-year Bachelor, Master or Doctor of Pharmacy degree from all three participating universities evaluated the workshop via pre- and post-questionnaires.

KEY FINDINGS

A total of 81 pharmacy students volunteered to attend and evaluate the workshop. Of these 81 students, 31 completed paired pre- and post-questionnaires, 44 students completed unpaired questionnaires and six students were lost to follow-up. Of the paired pre- and post-questionnaires, students were mostly female (67.7%) with an average age of 24.9 years (standard deviation, SD = 5.6) and were in the first (32.3%), second (16.1%) or third (51.6%) year of their pharmacy programme. Over 80% of students somewhat or strongly agreed that the workshop made them feel more comfortable speaking with young people in pharmacy settings. Mean (SD) perceived confidence (pre = 21.7 (4.0) and post = 24.9 (4.5)) and knowledge scores (pre = 5.2 (1.5) and post = 6.6 (1.6)) significantly improved after undertaking the workshop.

CONCLUSIONS

The workshop increased pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

Pharmaceutical care as narrative practice? Rethinking patient-centered care through a pharmacist's perspective

Illness is a disruptive experience that requires high-quality care. The best evidence-based medical treatment risks losing some of its efficacy, however, when patients feel misunderstood when faced with the complexity of their experiences. They might stop treatment, refuse to disclose relevant information or seek unsound alternatives. A narrative-based approach to health care understands the patient's case history as a narrative that can be read or analyzed like a story. In other words, this approach honors individual illness experiences through the stories that patients tell. While programs that train 'narrative competence' have been successfully implemented in medical education, an application to pharmaceutical training is missing so far. We argue for the necessity to complement evidence-based pharmaceutical practice with narrative-based approaches to ensure high-quality care. Using the perspective of a pharmacist in a case scenario, we exemplify the centrality of "narrative pharmacy" for improving the quality and safety of pharmaceutical health care.

What is Person-Centred Care? A Qualitative Inquiry into Oncology Staff and Patient and Family Experience of Person-Centred Care

INTRODUCTION

To investigate the understanding and practice of person-centred care by health care professionals and support staff at a cancer centre and to learn how patients and family members understand and experience person-centred care.

METHODS

The study was conducted in two phases. Phase 1 used large wall mounted posters and marking pens in public areas of the cancer centre to gather comments from staff, volunteers, students, patients, family members, and visitors to answer the question, "What does person-centred care mean to you?" Phase 2 used a six-question, open-ended, paper-based questionnaire for staff and patients. A manual coding technique was used to derive themes from both posters and questionnaires.

RESULTS

We derived 97 themes from the posters and 134 themes from 44 returned questionnaires (survey response rate of 37%). When the themes were combined and reprioritized, we learned that person-centred care is: (1) care that is caring, compassionate, and empathetic; (2) person or patient is the centre of focus; (3) care is unique to the individual's needs; and (4) person or patient is a part of their care. Furthermore, all staff should provide person-centred care.

CONCLUSIONS

Our findings describe what our staff, patients, and family members believe person-centred care is, and how it should be delivered. Based on this research study, we recommend promoting additional dialogue and continuing education opportunities for health care professionals and other front-line staff who will assist them to complete the statement, "I demonstrate person-centred care by…" to their own satisfaction in the future.