Patient desires: A model for assessment of patient preferences for care of severe or terminal illness

2005 ◽  
Vol 3 (4) ◽  
pp. 289-299 ◽  
Author(s):  
KAREN M. KNOPS ◽  
MALATHI SRINIVASAN ◽  
FREDRICK J. MEYERS
Keyword(s):  
Patient Preferences ◽  
Terminal Illness ◽  
Medical Professional ◽  
Patient Centered ◽  
Patients With Cancer ◽  
Patient Goals ◽  
Centered Care ◽  
Preferences For Care ◽  
Future Work

Objective: Patient-centered care is better achieved through a comprehensive understanding of patients' preferences for how they want to live their life and how they want to influence their own death. Though much has been written on identifying goals of care, it is often difficult for clinicians to articulate patient goals to guide care planning. We explored the literature on patient's preferences for their care in chronic or life-limiting illness to develop a model for assessment of patient perspectives. We then illustrated our model with composite patients from our clinics and we provide questions to guide patient discussion.Methods: We searched MEDLINE from 1986 to 2004 for primary research articles that relate primarily to a patient's preferences for his or her care. We reviewed over 3500 titles, abstracts, and research papers. Hundreds of articles described patients' quality of life, health status, or satisfaction. We excluded consensus guidelines, non-English papers, reviews, and articles focused on medical professional perspectives. Forty-eight studies focused primarily on patient preferences. Using an iterative process, we identified unique issues and broader themes in patients' desires for their care.Results: Studies focused on patients with cancer, those in hospice or those with terminal disease. Three domains emerged: patient feelings about disease, feelings about suffering, and feelings about the circumstances of death. Attention was given to the differences between patients in terms of the strength and persistence of feelings in each domain.Significance of results: Based on existing data, there are three fundamental domains of patient perspective that influence preferences for care. These domains can be assessed by the care team to guide the development of a plan of care and to identify areas of conflict. Our review identifies gaps in the end-of-life literature and areas for future work in patient preferences.

scholarly journals Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice

Hematology ◽  
2019 ◽  
Vol 2019 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Heidi D. Klepin
Keyword(s):  
Older Adults ◽  
Quality Of Care ◽  
Geriatric Assessment ◽  
Hematologic Malignancies ◽  
Patient Centered ◽  
Functional Reserve ◽  
Centered Care ◽  
Assessment Measures

Abstract Older adults represent the growing majority of patients diagnosed with hematologic disorders, yet they remain underrepresented on clinical trials. Older patients of the same chronologic age differ from one another with varying comorbidity and functional reserve. The concepts of frailty and resilience are important to patient-centered care and are patient and setting specific. The use of geriatric assessment to inform tailored decision making and management can personalize care for older adults with hematologic malignancies. This article will highlight available evidence to support the role of geriatric assessment measures to enhance quality of care for older adults diagnosed with hematologic malignancies.

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

scholarly journals Quality and safety by design

2006 ◽  
Vol 15 (suppl 1) ◽  
pp. i1-i3 ◽  
Author(s):  
J B Battles
Keyword(s):  
Healthcare Delivery ◽  
Clinical Work ◽  
Design Methods ◽  
Quality And Safety ◽  
Healthcare Organizations ◽  
Patient Centered ◽  
Framework Design ◽  
Design Attributes ◽  
Centered Care

Rather than continuing to try to measure the width and depths of the quality chasm, a legitimate question is how does one actually begin to close the quality chasm? One way to think about the problem is as a design challenge rather than as a quality improvement challenge. It is time to move from reactive measurement to a more proactive use of proven design methods, and to involve a number of professions outside health care so that we can design out system failure and design in quality of care. Is it possible to actually design in quality and design out failure? A three level conceptual framework design would use the six quality aims laid out in Crossing the quality chasm. The first or core level of the framework would be designing for patient centered care, with safety as the second level. The third design attributes would be efficiency, effectiveness, timeliness, and equity. Design methods and approaches are available that can be used for the design of healthcare organizations and facilities, learning systems to train and maintain competency of health professionals, clinical systems, clinical work, and information technology systems. In order to bring about major improvements in quality and safety, these design methods can and should be used to redesign healthcare delivery systems.

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana

2021 ◽  
pp. 104973232110608
Author(s):  
Carie Muntifering Cox ◽  
Ernest Tei Maya ◽  
Hamdi Mohamed Ali ◽  
Leslie Clayton
Keyword(s):  
Sub Saharan Africa ◽  
Patient Centered ◽  
Individualized Care ◽  
Centered Care ◽  
School Faculty ◽  
Sub Saharan ◽  
Common Barriers ◽  
Greater Accra Region ◽  
Single Facility

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

Integrative Oncology

2021 ◽  
pp. 470-478
Author(s):  
Santhosshi Narayanan ◽  
Gabriel Lopez ◽  
Jun J. Mao ◽  
Wenli Liu ◽  
Lorenzo Cohen
Keyword(s):  
Symptom Management ◽  
Care Plan ◽  
Integrative Approach ◽  
Evidence Based ◽  
Patient Centered ◽  
Open Communication ◽  
Patients With Cancer ◽  
Comprehensive Plan ◽  
Body Practices

Patients with cancer often seek an integrative approach to their care in hope of a cure or symptom management. The integrative care plan requires a patient-centered approach that involves attention to their concerns and developing a comprehensive plan involving physical, mind-body, and social modalities in collaboration with the patient’s main oncology team and colleagues in palliative care, pain management, psychiatry, and rehabilitation. A personalized symptom management strategy utilizing an evidence-based application of conventional and nonconventional therapies can help improve quality of life and optimize treatment outcomes. Recommendation of modalities such as acupuncture, massage, and mind-body practices, as well as open communication and discussion on herbs and supplements, their safety, and interactions with cancer and chemotherapy, is critical to achieve optimal clinical outcomes.

Active Medical Management Without Dialysis for Patients With Advanced Chronic Kidney Disease

2020 ◽  
pp. 136-147
Author(s):  
Kelly Li ◽  
Mark Brown
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medical Management ◽  
Symptom Management ◽  
Symptom Control ◽  
Shared Decision ◽  
Patient Centered ◽  
Advanced Chronic Kidney Disease ◽  
Centered Care

This chapter outlines the management of patients with advanced chronic kidney disease for whom dialysis may not be beneficial or desired. Active medical management without dialysis should be offered to patients through a shared-decision making process as a viable alternative to dialysis. This is important as patients and families wish to consider not only survival, but also symptom control and QoL in their decision to pursue a dialysis or nondialysis pathway. A multidisciplinary team delivering good quality, active, and patient-centered care that combines chronic kidney disease management with the principles of palliative care can help patients achieve good symptom management and quality of life. Active and early planning for the end-of-life phase facilitates appropriate care for patients in acute and/or unexpected deterioration and helps achieve patient and family goals.

scholarly journals Patient-Centered Care: An Examination of Provider–Patient Communication Over Time

2019 ◽  
Vol 6 ◽  
pp. 233339281988287
Author(s):  
Leslie Riggle Miller ◽  
B. Mitchell Peck
Keyword(s):  
Positive Impact ◽  
Patient Centered Care ◽  
Patient Communication ◽  
Self Report ◽  
Primary Data ◽  
Provider Communication ◽  
Patient Centered ◽  
Centered Care ◽  
Over Time

Objective: To examine the quality of provider communication over time considering the increasing emphasis on patient-centered care (PCC). Patient-centered care has been shown to have a positive impact on health outcomes, care experiences, quality-of-life, as well as decreased costs. Given this emphasis, we expect that provider–patient communication has improved over time. Data Source: We collected primary data by self-report surveys between summer 2017 and fall 2018. Study Design: We use a quantitative retrospective cohort study of a national sample of 353 patients who had an ostomy surgery. Data Extraction Method: We measure provider communication from open-ended self-reports from patients of the number of stated inadequacies in their care. Principal Findings: Results show that the time since patients had their surgery is related to higher quality provider communication. That is, patients who had their surgery further back in time reported higher quality provider communication compared with patients who had their surgery performed more recently. Conclusion: Results suggest that the quality of provider communication has not improved even with an emphasis on PCC.

scholarly journals The evolution of quality improvement in healthcare: Patient-centered care and health information technology applications

2016 ◽  
Vol 5 (2) ◽  
pp. 62 ◽  
Author(s):  
John Cantiello ◽  
Panagiota Kitsantas ◽  
Shirley Moncada ◽  
Sabiheen Abdul
Keyword(s):  
Information Technology ◽  
Quality Improvement ◽  
Health Information Technology ◽  
Health Information ◽  
Patient Centered Care ◽  
Healthcare Industry ◽  
Patient Centered ◽  
Technology Applications ◽  
Centered Care

Objective: Quality improvement in the healthcare industry has evolved over the past few decades. In recent years, an increased focus on coordination of care efforts and the introduction of health information technology has been of high importance in improving the quality of patient care.Methods: In this review, we present a history of quality improvement efforts, discuss quality improvement in the healthcare industry, and examine quality improvement strategies with a focus on patient-centered care and information technology applications via patient registries.Results: Evidence shows that the key to quality improvement efforts in the healthcare industry is the coordination of patient care efforts through better data evaluation processes. By utilizing patient registries that can be linked to electronic health records (EHRs) and the Patient-Centered Medical Home (PCMH) framework, the quality of care provided to patients can be improved.Conclusions: While many healthcare organizations have quality improvement departments or teams in place that may be able to handle these types of efforts, it is important for organizations to be familiar with processes and frameworks that employees at different levels of the organization can be involved in. In order to ensure successful outcomes from quality improvement initiatives, managers and clinicians should work together in identifying problems and developing solutions.

scholarly journals How could discourse theories of identity formation critically engage patient-centered care in older adults?

2018 ◽  
Vol 19 (3) ◽  
pp. 205-216
Author(s):  
Anna Horton ◽  
Simon Horton
Keyword(s):  
Older Adults ◽  
Older People ◽  
Identity Formation ◽  
Design Methodology ◽  
Patient Centered ◽  
Content Type ◽  
Clinical Encounters ◽  
Centered Care ◽  
Conceptual Paper

Purpose The purpose of this paper is to explore how discourse theories can contribute to the concept of identity formation within a patient- or person-centered care (PCC) orientation, to enable more critical engagement with PCC in older people. Design/methodology/approach This is a conceptual paper. Findings This paper concludes that the discourse literature has important insights for understanding identity formation in older people as operationalized in the context of PCC in three particular ways: accounting for multiplicity in patients’ identity; exploring “the devolution of responsibility” to address shifts in performing identities in clinical encounters; and attending to a “crisis of positioning” to engage empowerment discourse within a PCC philosophy. Originality/value Whilst a notion of patient identity is at the heart of PCC, the concept remains inconsistent and underdeveloped. This is particularly problematic for the quality of care in older adults, as PCC has become increasingly synonymous with care of older people. Discourse theories of identity formation can be used to critically engage with identity within the context of PCC, so as to develop more nuanced understandings of “the person” or “the patient,” with the potential to improve research into care for aging and older adults.

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