Day 7 - Patient and Family Centered Care (PDF)

**DAY 7 - PATIENT AND FAMILY CENTERED CARE** **DATA AND EVIDENCE\ ** **An Illustration of the Committee's Conceptual Framework for Improving the Quality of Cancer Care** **About This Model -- Applied to a Cancer Setting** - Emphasizes the significance of engaging patients - Patients are at...

**DAY 7 - PATIENT AND FAMILY CENTERED CARE** **DATA AND EVIDENCE\ ** **An Illustration of the Committee's Conceptual Framework for Improving the Quality of Cancer Care** **About This Model -- Applied to a Cancer Setting** - Emphasizes the significance of engaging patients - Patients are at the centre of the framework, which conveys the most important goal of a high-quality cancer care delivery system: meeting the needs of patients with cancer and their families. - The goal is to support patients and families to make health care decisions that align with their values. - Health care providers and agencies need to be prepared to give care that respects and responds to patient values, and supports patients in guiding decisions related to their care. - Patient-centred care includes fostering good communication between patients and their cancer care team; developing and disseminating evidence-based information to inform patients, caregivers, and the cancer care team about treatment options; and practicing shared decision making. **How is This Implemented into the Cancer Setting?** - Patient education and empowerment - Patient-centred communication, which involves the patient, family, and friends; explains treatment options; and includes patients in treatment decisions to reflect patients\' values, preferences, and needs - Coordination and integration of care - Provision of emotional support as needed, such as relieving fear and anxiety and addressing mental health issues **Effective Patient-Clinician Communication** - ***Effective patient-clinician communication*** and ***shared decision making*** are key components of patient-centred care. - These components require that informed, activated, and participatory patients and family members interact with a patient-centred care team that has effective communication skills and is supported by an accessible, well-organized, and responsive health care system. **Primary Functions of Patient-Centred Communication**\ The following ***six primary functions of patient-centred communication*** dynamically interact to influence the quality of patient-clinician interactions and may ultimately influence patients\' health outcomes: 1. Foster healing relationships -- patient provider relationship 2. Exchange information -- evidence based related to the disease 3. Respond to emotions -- emotionally supported 4. Manage uncertainty 5. Make decisions -- best decision suitable for the patient 6. Enable patient self-management -- family, financial, work related **Model of Patient-Centred Care** - The patient, clinicians, and health care system dynamically interact to influence patient-centred care. - The delivery of patient-centred care has the potential to improve communication and health outcomes. **The Result of Shared Decision-Making** - Health researchers, advocacy organizations, and the Agency for Health Care Research and Quality (AHRQ) have encouraged patients to play a larger role in making medical decisions. - Research indicates that when patients are involved in their own care, they are more satisfied with the care they receive and often experience better health outcomes. - Shared decision making is a critical feature of patient-centred communication and is defined as "the process of negotiation by which physicians and patients arrive at a specific course of action, based on a common understanding of the goals of treatment, the risks and benefits of the chosen treatment versus reasonable alternatives, and each other\'s values and preferences". **It is Complicated and the Outcome is Positive** - Patients with cancer and their families are often required to manage greater portions of their cancer care due to advances in cancer treatment, as well as changes in the practice of health care, such as earlier discharge from the hospital. - These duties may include drug management, wound care, rehabilitation, and lifestyle changes. - Clinicians help patients engage in self-management, which involves managing the medical and psychological aspects of cancer care, as well as adapting to changes in roles that result from cancer diagnosis. - Promoting patient self-management can facilitate shared decision making and improve cancer care. **The Importance of Patient-Centred Care** A number of factors related to cancer care necessitate a patient-centred approach to communication: 1. Cancer care is extremely complex and patients\' treatment choices have serious implications for their health outcomes and quality of life; 2. The evidence supporting many decisions in cancer care is limited or incomplete; and 3. Trade-offs in the risks and benefits of cancer treatment choices may be weighed differently by individual patients, and clinicians need to elicit patient needs, values, and preferences in these circumstances. **Challenges in Shared Decision-Making** - The impact of the diagnosis on patients and their families. - Clinicians may not have the time to really "listen" to the patient and their families - The Cancer Care System is fragmented **Improving Communication and Shared Decision Making** - Making more comprehensive information available - Improving shared decision-making using decision aids - Prioritizing clinician training in communication - Communicating information and preparing care plans - Implementing care planning **Making More Comprehensive Information Available** - Having resources available that patients can understand, are accurate, and supportive. - A number of trusted organizations have developed print, electronic, and social resources to inform patients and their families about cancer. - Finding accurate, useful cancer information online can be a major challenge for patients and their families. **Improving Shared Decision-Making Using Decision Aids** - A priority of communication is to ensure that patients make decisions which meet their needs. - Health care providers can improve patient-centred communication and shared decision making by listening actively, assessing a patient\'s understanding of treatment options, validating a patient\'s participation in the decision-making process, and communicating empathy both verbally and nonverbally. - Decision making can be enhanced by accessing decision tools that support patient comprehension of treatment choices and help patients be more engaged in decision making. - "A decision aid is a tool that provides patients with evidence-based, objective information on all treatment options for a given condition". - Decision aids present the risks and benefits of all options and help patients understand how likely it is that those benefits or harms will affect them -- includes written material, web-based tools, videos, and multimedia programs. **Prioritizing Clinician Training in Communication** - Health care providers need to communicate effectively with patients to build patient-clinician relationships focused on trust and rapport, exchange information, respond to patient emotions, manage the uncertainty associated with a cancer diagnosis and treatment, participate in shared decision making, and enable patient self-management. - Effective communication is associated with patients experiencing faster recovery, improved pain control, and better psychological functioning. - It is also critically important for clinicians to provide patients with the opportunity to discuss this information in real time with members of the cancer care team. - Technology-enabled approaches, such as telemedicine, may increase the opportunity for patients to have these interactions. **Communicating Info and Preparing Cancer Care Plans** The health care provider team should: - Provide patients and their families with understandable information on cancer prognosis, treatment benefits and harms, palliative care, psychosocial support, and estimates of the total and out of pocket costs of cancer care. - Communicate and personalize this information for their patients at key decision points along the continuum of cancer care, using decision aids when available. - Collaborate with their patients to develop a care plan that reflects their patients\' needs, values, and preferences, and considers palliative care needs and psychosocial support across the cancer care continuum. **What is System Thinking?** - A ***system*** is defined as a set of "interrelated components working together towards a common goal" with "a defined structure and function". - A ***systems thinking approach*** is different than the traditional person-focused approach. - In person-focused organizations, individuals are blamed for a lack of safety and interventions to improve safety are targeted at improving the blamed individuals by imploring them to be more careful or sending them to more training. - A system-focused approach to safety focuses on the conditions under which people...the system. - Interventions to improve safety focus on redesigning the system to make it both more difficult to error in the first place and to make those patient safety incidents that do happen easily identifiable so that their effects can be quickly mitigated. - By using a systems approach, we then begin to appreciate that most patient safety incidents and safety problems are the result of the many interactions among processes and workflows, technology designs, teamwork, staff, patients, financial restraints, training, and education that occur within the health care system. **Care Delivery Prioritizes Needs** - Care delivery prioritizes the needs of patients, health care staff, and the larger community. - Improve health literacy among members of a community so they know what high-quality care looks like and can hold caregivers accountable. - Doing so will incline patients to return to facilities, establish good relationships between facilities and the community, and give care providers a comfortable and minimally stressful work environment, thereby helping to achieve good health outcomes, continual improvement, and financial sustainability for facilities. **Trade-Offs in Health Care** - Trade-offs in health care reflect societal values and priorities. - Leaders should base the trade-offs made on the values of their own communities and health facilities, taking national cultural factors into account. **Care Integration and Coordination** - Care is integrated and coordinated across the patient journey. - The system should track the patient journey---not just over multiple encounters but ideally over a person\'s life course. - This would enable more seamless coordination among multiple organizations and open up a channel for dialogue between the health system and the person to capture the patient\'s experience. **Collaboration in Systems Design** - Patients and health care providers should collaborate in systems design. - For best results, it is required that the transformation process begin and finish with feedback and participation from patients and providers. - Such a human-centred approach is emerging in global health, being used most frequently with digital health technologies to maximize their impact when introduced in the field. - It will be important for health systems to build health literacy among their populations. - Patients and providers should co-design a systems approach to health care. **Transformation of Care Delivery** - The transformation of care delivery is driven by continuous feedback, learning, and improvement. - Health care leaders should seek to implement a system that generates data, provides continual feedback, and creates opportunities for learning and improvement. - This is a first step toward creating the culture of a learning health care system. **In Summary...** - Care delivery can be further characterized as person-centred if it takes societal values into account. - Health care by its very nature is a social endeavour as it consists of interactions among people. - It is necessary to engage multiple stakeholders in decision making on how to structure service delivery and direct resources, creating a foundation on which patients and health care staff can co design changes to make health care more person-centred. **Involvement in Systems Thinking** - The goal of making health care more unified and synchronized and to make steering of the care delivery system more transparent, care should be designed to enhance interaction for patients. - Integration of care allows patients and their families to access multiple, related services at the same facility instead of traveling to multiple sites, while coordination of care assists patients with multiple health needs. - Involving patients in systems thinking facilitates the integration and coordination of care. Quality of patient services improve, and care becomes more transparent. Care becomes more seamless. - It is important to note that integration and coordination of services will likely be of little value unless health care facilities are open at times convenient for patients. **Recommendations** Redesign health care using systems thinking: - Systems thinking drives the transformation and continual improvement of care delivery. - Care delivery prioritizes the needs of patients, health care staff, and the larger community. - Decision making is evidence based and context specific. - Trade-offs in health care reflect societal values and priorities. - Care is integrated and coordinated across the patient journey. - Care makes optimal use of technology to be anticipatory and predictive at all system levels. - Leadership, policy, culture, and incentives are aligned at all system levels to achieve quality aims, and to promote integrity, stewardship, and accountability. - Navigating the care delivery system is transparent and easy. - Problems are addressed at the source, and patients and health care staff are empowered to solve them. - Patients and health care staff co-design the transformation of care delivery and engage together in continual improvement. - The evolution of care delivery is supported by ongoing feedback, knowledge, and improvement. - The transformation of care delivery is a multidisciplinary process with adequate resources and support. - The transformation of care delivery is supported by invested leaders.