What do we mean by person-centred approaches in heart failure?
What is person-centred care?
There is no single definition of person-centred care. However most models (and their related terms) share an underlying recognition that health and wellbeing are closely linked, and that mutual respect and partnership between care professionals and patients are indispensable for effective, high quality care.
Common components of person-centred care include:
- shared decision making
- self-management support
- care planning and goal setting
- listening and patient narratives
- integrated (or co-ordinated) care
Why is person-centred care important in heart failure?
- Person-centred care is essential in heart failure (HF) for many reasons. As with many chronic diseases a great deal of all care is likely to be self-care – such as protective lifestyle behaviours, self-monitoring, and adherence to medical treatment (see other feature ‘What are the key components of self-management in HF’)
- HF is often a traumatic diagnosis, and a ‘lived condition’. Psychological health and individual motivation are therefore important factors, and humane, responsive approaches to decision-making are important in building trust between professionals and patients.1
- Many aspects of person-centred care have been shown to work. For example, effective self-management is critical to help patients achieve good health outcomes.2 Appropriate information and support to patients (therapeutic education) has been shown keep patients out of hospital and improve their quality of life.2 3
- The coordination of care, including regular medical check-ups and the ongoing management of co-morbidities is also vital, as is a seamless transition across healthcare settings, for example during hospital discharge.
- Models of person-centred care planning and listening have shown significant benefits in HF, for example in shortening hospital stays,4 improving quality of life and morbidity5 and reducing patient uncertainty and confusion.6
- Of all patients with HF readmitted to hospital, over half of admissions could be avoided through careful discharge planning, appropriate patient education and personalised follow up in the community.7
What do some of the related terms and concepts mean?
An explanation of some of the most common components and related terms is given below.
- Shared decision making
Shared decision making has been defined an interpersonal, interdependent process in which the health care provider and the patient relate to and influence each other as they collaborate in making decisions about the patient’s health care.11 Good shared decision making should encompass the available medical evidence, the provider’s clinical expertise, and the unique attributes of the patient and his or her family.11
- Self-management support
Self-management is typically associated with long term chronic conditions (such as heart failure), and may involve a complicated range of tasks, requiring confidence and skill from the patient. This may include taking medicines properly, monitoring symptoms, adopting or maintaining healthy lifestyles, managing emotions, solving practical problems, knowing when and how to seek medical advice or community support, and coping with the impact of the condition(s) on their daily lives.12
- Person-centred care planning
Person-centred, or (‘personalised’) care planning has been described as a conversation, or series of conversations, between a patient and a clinician when they jointly agree on goals and actions for managing the patient’s health problems.12 Such support recognises patients’ concerns, personal strengths and self-knowledge, and helps them become more able to manage their own health.
- Listening and patient narratives
Listening to and documenting patient narratives has been developed in leading models of person-centred care in HF as a structured and planned activity, 13 14 where the patient narrative constitutes the starting point for person-centred care and acts as the basis for shared decision making, care planning, and partnership and trust between patient and healthcare professionals.13
- Integration and coordination of care
Many definitions exist,15 but a leading report identified the four following aspects of integrated working as follows:16
- Functional: integration of key support functions and activities, such as financial management, strategic planning and human resource management;
- Organizational: for example, creation of networks, mergers, contracting;
- Professional: for example, joint working, group practices, contracting or strategic alliances of health-care professionals within and between institutions and organizations;
- Clinical: integration of the different components of clinical processes, such as coordination of care services for individual health-care service users or care pathways
Most leading definitions affirmed the needs and perspective of the patients as the dominant principles of integrated and coordinated care. 17-20
- Barello S, Graffigna G, Vegni E, et al. ‘Engage me in taking care of my heart’: a grounded theory study on patient-cardiologist relationship in the hospital management of heart failure. BMJ Open 2015;5(3):e005582.
- Jaarsma T, Stromberg A, Ben Gal T, et al. Comparison of self-care behaviors of heart failure patients in 15 countries worldwide. Patient education and counseling 2013;92(1):114-20.
- Stromberg A. The crucial role of patient education in heart failure. Eur J Heart Fail 2005;7(3):363-9.
- Ekman I, Wolf A, Olsson L-E, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. European Heart Journal 2011.
- Brannstrom M, Boman K. Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. European journal of heart failure 2014;16(10):1142-51.
- Dudas K, Olsson LE, Wolf A, et al. Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2013;12(6):521-8.
- Paul S. Hospital discharge education for patients with heart failure: what really works and what is the evidence? Critical care nurse 2008;28(2):66-82.
- Mocillo C, Valderas J, Aguado O, et al. Evaluation of a Home-Based Intervention in Heart Failure Patients. Results of a Randomized Study. Revista Española de Cardiología 2005;58(6):18-25.
- Roig E, Pérez-Villa F, Cuppoletti A, et al. Specialized Care Program for End-Stage Heart Failure Patients. Initial Experience in a Heart Failure Unit. Revista Española de Cardiología 2006;59(2):109-16.
- Anderson C, Deepak BV, Amoateng-Adjepong Y, et al. Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure. Congestive heart failure (Greenwich, Conn) 2005;11(6):315-21.
- Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Affairs 2013;32(2):276-84.
- Coulter A, Entwistle VA, Eccles A, et al. Personalised care planning for adults with chronic or long‐term health conditions. The Cochrane Library 2015.
- Ekman I, Swedberg K, Taft C, et al. Person-centered care—Ready for prime time. European Journal of Cardiovascular Nursing 2011;10(4):248-51.
- Williams A, et al. The Listening Organisation Ensuring care is person-centred in NHS Wales. Improving Healthcare White Paper Series 2013;No.11.
- Goodwin N, Smith J, Davies A, et al. A report to the Department of Health and the NHS Future Forum – Integrated care for patients and populations: Improving outcomes by working togethe: The King’s Fund, Nuffield Trust, 2012.
- Nolte E, Pitchforth E. What is the evidence on the economic impacts of integrated care? , 2014.
- Curry N, Ham C. Clinical and service integration- The route to improved outcomes: The King’s Fund, 2010.
- Shaw S, Rosen R, Rumbold B. What is integrated care?: Nuffield Trust, 2011.
- National Voices. A Narrative for Person-Centred Coordinated Care. In: Voices N, ed. Think Local Act Personal. NHSE, 2013.
- Lloyd J, Wait S. Integrated Care – A Guide for Policymakers. London, UK: International Longevity Centre – UK, 2006.