Table 3 Topics derived from the focus groups and assignment to categories (i.e. dimensions of patient-centeredness) and levels of health care
From: Patient-centeredness in the multimorbid elderly: a focus group study
Micro level of care (patient interaction) | ||
Category | Descriptiona | Associated topic during discussion |
Patient as a unique person | Recognition of each patient’s uniqueness (individual needs, preferences, values, feelings, beliefs, concerns and ideas, and expectations). | Individual patient characteristics (e.g., health status, personality) Individual health care preferences (e.g., related to specific treatment, medication) Usefulness of patient decrees Individualization of health care / treatment plans |
Individual care needs related to aging and chronic disease | Refers to the individual prognosis, life expectancy, treatment and disease burden, as well as natural aging processes. | Prognosis Individual treatment / disease burden Age-specific anxiety / uncertainty Aging process / gradual frailty / dependence Polymedication: check for interaction between drugs More time needed for health care visits of older multimorbid patients Preference for ‘in-home nursing’, e.g., by nonprofessional, foreign nurses (including structural and financial preconditions) |
Biopsychosocial perspective | Focuses on the development and context of an individual patient, i.e. non-medical and relatively stable characteristics of a patient and his living situation. | Living situation (e.g., home nursing, sick relative) Availability of and support by relatives Loss of partner / loneliness |
Clinician-patient communication | Refers to concrete or even observable aspects of communication that may, in turn, shape the relationship between patient and clinician. | Personal experiences of failed / poor communication with clinician (e.g., clinician vehemently tries to alter the patient’s decision) Clinician: ask the patient questions (e.g., about side-effects of medication) Clinician: encourage the patient to utter doubts or contradictory views Clinician: include a personal instead of a mere professional communication style |
Essential characteristics of the clinician | Comprises personal characteristics of the clinician that patients describe as desirable. | Empathy, commitment, forthrightness Expertise, specialization, experience |
Clinician-patient-relationship | Refers to a central principle of patient-centeredness, namely a good relation and professional partnership between patient and clinican. | Clinician: Patience and understanding Clinician: Respect for the patient (listen carefully, take patient seriously, care for patients’ needs) Trust between patient and clinician Clinician: Consider the patient’s individual life story |
Patient involvement in care | Considers the patient as an active collaborator of the clinician who should be actively involved in decisions on his health care as far as he prefers to. | Preference for and positive experience with shared decision making Mismatch between the clinician’s communication style and the patient’s communicational preferences Clinician: Overstraining patients with increased responsibility and involvement |
Patient information | Describes the provision of patient-tailored health care information under considerance of the patient’s information needs and preferences. | Visibility and comprehensibility of written information Information on treatment alternatives, side-effects of medication and prognosis Holistic approach: Information on disease effects on general condition, possible changes in behavior and consequences for everyday life Lists with contact persons / Uncertainty about whom to ask for information Information on waiting times at hospitals Consider informational preferences: Confusion and uncertainty by too few, too much or inadequate / contradictory information GPs as ‘translator’ of incomprehensible information |
Involvement of family and friends | Active involvement of and support for the patient’s relatives and friends to the degree that the patient prefers. | Clinician: Provide relatives with information on the patient’s medical condition, implications of the disease for everday living Clinician: Ask relatives for information (e.g., about the patient’s medical preconditions) |
Patient empowerment | Recognition and active support of the patient’s ability and responsibility to self-manage his or her disease | Clinician: Provide the patient with specific brochures and clinical recommendations on self-management options Clinician: Encourage patients to take over responsibility Clinician: Accept patient’s opinion Patient: Induce changes in lifestyle and health behavior, e.g., memory training, fitness course, healty diet Patient: Search for information, e.g., on health-related self-management activities Patient: ‘Look after oneself, especially in old age (e.g., avoid infections) |
Physical and emotional support | Recognition of the patient’s physical and emotional need and behaviors that address these needs | Physical: Usefulness of home care services Physical: Availability, costs and ‘adaptability’ of technical advices such as walking frames, nursing beds Physical: Patient safety (intimate hygiene in hospitals) Inter- and intrapersonal variability of support needs Emotional (clinician): Responsiveness to patients’ fears Clinician: Recommend / prescribe additional or integrative therapies (e.g., psychotherapy) Clinician: Assess and account for support needs (e.g., physical impairments / disabilities of a patient) Emotional (clinician): Reduce the patient’s uncertainty by informing him |
Meso level of care (health care organization and community) | ||
Category | Descriptiona | Associated topic during discussion |
Coordination and continuity of care | Refers to the coordination between different care providers and services as well as the continuity of care (e.g., in terms of optimized transitions). | GP as gate-keeper (coordinator, pooling of information) Importance of prearranging medical aftercare Importance of exchanging information between different care providers Usefulness of community health centers or joint practices due to integration of different professions Increasing responsibility of family members regarding the coordination of health care with progressing age and / or disease severity |
Integration of medical and non-medical care | Refers to the recognition and integration of non-medical aspects of care (e.g., patient support services) into health care services. | Special prevention and after-care programmes Prescription / recommendation of non-medical care (e.g., homeopathy, psychotherapy, physiotherapy) |
Teamwork and teambuilding | Facilitation of effective teams characterized by a set of qualities (e.g., respect, trust, shared responsibilities, values, and visions) | Insufficient communication between medical doctor and doctor’s receptionist |
Meso / macro level of care (health care organization and community / policy and regulations) | ||
Category | Descriptiona | Associated topic during discussion |
Access to care | Refers to the availability and timely accessibility of individually appropriate health care services and institutions (e.g., decentralized services). | Patient: Insufficient knowledge about contact persons and institutions Institutions / policy: Impairments by bureaucracy Institutions: Waiting times for or at medical appointments, technical aids etc. Institutions: GP as first contact person in the health care system Institutions: Need for community health centers located in the neighborhood area Institutions / policy: Underpayment of health care staff Policy: Insufficient financing of medical services by insurers |