What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews

2012 ◽  
Vol 87 (2) ◽  
pp. 206-211 ◽  
Author(s):  
Alain Moreau ◽  
Laurent Carol ◽  
Marie Cécile Dedianne ◽  
Christian Dupraz ◽  
Corinne Perdrix ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Group ◽  
Qualitative Study ◽  
Patient Centered Care ◽  
Care Model ◽  
Focus Group Interviews ◽  
Patient Centered ◽  
Centered Care ◽  
Group Interviews

Can opioid vigilance and patient-centered care coexist? A qualitative study of communicative tensions encountered by surgical trainees

2020 ◽  
Vol 16 (2) ◽  
pp. 91-101
Author(s):  
Elizabeth Troutman Adams, MA ◽  
Elisia L. Cohen, PhD ◽  
Andrew Bernard, MD ◽  
Whittney H. Darnell, PhD ◽  
Douglas R. Oyler, PharmD
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Medical Profession ◽  
Descriptive Analysis ◽  
Skills Training ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Opioid Prescribing ◽  
Surgical Trainees ◽  
Centered Care

Objective: The American health care system's adoption of the patient-centered care (PCC) model has transformed how medical providers communicate with patients about prescription pain medication. Concomitantly, the nation's opioid epidemic has necessitated a proactive response from the medical profession, requiring providers who frequently dispense opioids for acute pain to exercise vigilance in monitoring and limiting outpatient prescriptions. This qualitative study explores how surgical trainees balance PCC directives, including shared decision making, exchanging information with patients, and relationship maintenance, with opioid prescribing vigilance.Design: Investigators conducted interviews with 17 surgical residents and fellows (trainees) who routinely prescribe opioids at an academic medical center.Results: A qualitative descriptive analysis produced four codes, which were reduced to themes depicting problematic intersections between PCC imperatives and opioid vigilance during post-operative opioid-prescribing communication: (a) sharing the decision-making process contended with exerting medical authority, (b) reciprocating information contended with negotiating opioid prescribing terms with patients, (c) maintaining symbiotic relationships contended with prescribing ethics, and (d) achieving patient satisfaction contended with safeguarding opioid medications.Conclusion: Surgical training programs must supply trainees with post-surgical prescribing guidelines and communication skills training. Training should emphasize how PCC directives may work in tandem with--not in opposition to--opioid vigilance.

scholarly journals Patient-centeredness in the multimorbid elderly: a focus group study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manuela Kanat ◽  
Jonas Schaefer ◽  
Laura Kivelitz ◽  
Jörg Dirmaier ◽  
Sebastian Voigt-Radloff ◽  
...  
Keyword(s):  
Focus Group ◽  
Older Patients ◽  
Integrative Model ◽  
Focus Group Interviews ◽  
Patient Centeredness ◽  
Care Needs ◽  
Patient Centered ◽  
Individual Care ◽  
Centered Care ◽  
Group Interviews

Abstract Background  Patient-centeredness (PC) aims to adapt health care to the individual needs and preferences of patients. An existing integrative model of PC comprises several dimensions of PC which have not yet been investigated from the patients’ perspective. Older patients with multimorbidity represent a target group for patient-centered care, as their care needs are particularly complex and should be addressed individually. We aimed to assess the perspective that older patients with multimorbidity have of patient-centered care and to examine the transferability of the integrative model of PC to this specific population. Method We performed 4 guided focus group interviews with a total of 20 older individuals with multimorbidity. The focus group interviews were audio-recorded and transcribed verbatim. Patients’ statements were content-analyzed applying an a priori designed system of categories that included the dimensions of PC from the integrative model and the additional category ‘prognosis and life expectancy’, which had emerged from an initial literature search on aspects of PC specific to the multimorbid elderly. Results The new category ‘prognosis and life expectancy’ was confirmed and expanded to ‘individual care needs related to aging and chronic disesase’. All dimensions of our integrative PC model were confirmed for older patients with multimorbidity. Among these, we found that eight dimensions (individual care needs related to aging and chronic disease, biopsychosocial perspective, clinician-patient communication, essential characteristics of the clinician, clinician-patient-relationship, involvement of family and friends, coordination and continuity of care, access to care) were complemented by aspects specific to this target population. Conclusions The integrative PC model is applicable to the population of older patients with multimorbidity. For a population-specific adaptation, it might be complemented by the dimension ‘individual care needs in aging and chronic disease’, in conjunction with age-specific aspects within existing dimensions. Together with corresponding results from a Delphi survey, our adapted PC model will serve as the basis for a subsequent systematic review of instruments measuring PC in older patients with multimorbidity. Trial registration PROSPERO (https://www.crd.york.ac.uk/prospero; CRD42018084057; 2018/02/01), German Clinical Trials Register (www.drks.de; DRKS00013309; 2018/01/23).

scholarly journals Students' perceptions of interprofessional collaboration on the care of diabetes: A qualitative study of focus-group interviews

2020 ◽  
Author(s):  
Sanna Pauliina Kangas ◽  
Pia Jaatinen ◽  
Saara Metso ◽  
Rintala Tuula-Maria
Keyword(s):  
Nursing Students ◽  
Focus Group ◽  
Qualitative Study ◽  
Interprofessional Education ◽  
Interprofessional Collaboration ◽  
Perceived Competence ◽  
Focus Group Interviews ◽  
Patient Centered ◽  
Before And After ◽  
Group Interviews

Abstract Background: Interprofessional education (IPE) can promote healthcare professionals’ competence to work in interprof­­essional collaboration (IPC), whi­­­­ch is essential for the quality and safety of care. An interprofessional approach is particularly important in complex, chronic diseases like diabetes. A number of studies have been published on IPE, but only a few with a qualitative approach.Methods: The objective of this qualitative study was to evaluate changes in medical and nursing students’ perceptions of IPC, induced by a novel IPE course on diabetes care. The data from focus-group interviews of 30 students before and after the course were analyzed by using an inductive and deductive content analysis.Findings: The students´ perceptions were illustrated as Elements of interprofessional care (e.g. Elements formulating care team and Quality of professional care relationship ) and Elements of IPC (e.g. Importance of communication and Valuation of collaboration ). The post-course interviews added one subcategory ( Need of resources ) to the pre-course perceptions, and there was improvement in ten areas of self-perceived competence in performing or understanding IPC on diabetes care.Conclusions: The IPE course piloted in this study increased the students’ self-perceived competence and confidence in performing IPC on the care of diabetes, and changed their understanding of IPC towards a more patient centered and holistic perspective. More research is needed to evaluate the generalizability and sustainability of these changes.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

scholarly journals Benchmarking European Home Care Models for Older Persons on Societal Costs: The IBenC Study

2021 ◽  
Vol 14 ◽  
pp. 117863292110224
Author(s):  
Lisanne I van Lier ◽  
Henriëtte G van der Roest ◽  
Vjenka Garms-Homolová ◽  
Graziano Onder ◽  
Pálmi V Jónsson ◽  
...  
Keyword(s):  
Home Care ◽  
Patient Centered Care ◽  
Mean Difference ◽  
Care Model ◽  
Patient Centered ◽  
Societal Costs ◽  
Centered Care ◽  
Care Models ◽  
Prospective Longitudinal ◽  
Care Performance

This study aims to benchmark mean societal costs per client in different home care models and to describe characteristics of home care models with the lowest societal costs. In this prospective longitudinal study in 6 European countries, 6-month societal costs of resource utilization of 2060 older home care clients were estimated. Three care models were identified and compared based on level of patient-centered care (PCC), availability of specialized professionals (ASP) and level of monitoring of care performance (MCP). Differences in costs between care models were analyzed using linear regression while adjusting for case mix differences. Societal costs incurred in care model 2 (low ASP; high PCC & MCP) were significantly higher than in care model 1 (high ASP, PCC & MCP, mean difference €2230 (10%)) and in care model 3 (low ASP & PCC; high MCP, mean difference €2552 (12%)). Organizations within both models with the lowest societal costs, systematically monitor their care performance. However, organizations within one model arranged their care with a low focus on patient-centered care, and employed mainly generalist care professionals, while organizations in the other model arranged their care delivery with a strong focus on patient-centered care combined with a high availability of specialized care professionals.

scholarly journals A Qualitative Study on Employees’ Experiences of a Support model for Systematic Work Environment Management

2019 ◽  
Vol 16 (19) ◽  
pp. 3551 ◽  
Author(s):  
Therese Hellman ◽  
Fredrik Molin ◽  
Magnus Svartengren
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Work Environment ◽  
Work Groups ◽  
Comparative Method ◽  
Focus Group Interviews ◽  
Environment Management ◽  
Group Interviews ◽  
Over Time ◽  
Support Model

Background: The aim is to explore how an organisational work environment support model, the Stamina model, influences employees’ work situations and the development of sustainable work systems. Methods: It was a qualitative study with semi-structured, focus-group interviews, including 45 employees from six work groups. Eighteen focus group interviews were conducted over a period of two years. Data were analysed with constant comparative method. Results: The core category, shifting focus from an individual to an organisational perspective of work, illustrated how communication and increased understanding of one’s work tasks changed over time and contributed to deeper focus on the actual operation. These insights were implemented at different time points among the work groups during the two-year process. Conclusions: Our results indicate that working with the model engages employees in the work environment management, puts emphasis on reflections and discussions about the meaning and purpose of the operations and enables a shared platform for communication. These are important features that need to continue over time in order to create a sustainable work system. The Stamina model, thus seems to have the potential to promote productive and healthy work places.

How accessible are grocery shops for people with dementia? A qualitative study using photo documentation and focus group interviews

Dementia ◽  
2018 ◽  
Vol 19 (6) ◽  
pp. 1872-1888 ◽  
Author(s):  
Anna Brorsson ◽  
Annika Öhman ◽  
Stefan Lundberg ◽  
Malcolm P Cutchin ◽  
Louise Nygård
Keyword(s):  
Grounded Theory ◽  
Focus Group ◽  
Qualitative Study ◽  
Grocery Shopping ◽  
Theory Approach ◽  
Focus Group Interviews ◽  
People With Dementia ◽  
Photo Documentation ◽  
Group Interviews ◽  
Grounded Theory Approach

Background People with dementia who live in ordinary housing need to perform activities outside the home such as visiting friends, talking walks and doing grocery shopping. This article identifies and examines characteristics that may influence accessibility in the space of a grocery shop as perceived by people with dementia. Methods This is a qualitative study with a grounded theory approach. The data collection was done with two different methods. It started with photo documentation and continued with focus group interviews in combination with photo elicitation. Data from both photo documentation and focus groups were analysed according to a grounded theory approach. Results The categories “illogical arrangement”, “overload of products, information and people”, “visual illusions” and “intrusive auditory stimuli” showed characteristics in the grocery shop that influenced how accessible and usable the informants experienced a shop to be. Furthermore, personal capacities in relation to the specific characteristics of the grocery shop space had an influence on how accessible and usable the informants experienced the grocery shop to be. Capacities to find, stay focused and concentrated, meet stress, remember, interpret and discriminate sensory impressions through hearing and sight came to the fore as important. Conclusions Characteristics of both the shop and the person need to be taken into account when supporting people with dementia in grocery shopping.

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