出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : Person-centered care is regarded as key aspect of modern, good quality care. However, there is little consensus about the definition of person centered care [1] and – like integrated care – different words are used for similar concepts (for example: ‘patient centered care’, ‘people centered care’, ‘people-centered health services’ and ‘client centered care’). In addition, it is difficult to measure the degree of person-centeredness in practice. And existing instruments are not developed in cooperation with the main stakeholders: clients, their relatives and professional caregivers. The aim of this research project was to identify essential themes of person-centered care from the perspectives of clients, their relatives and care givers in different settings (residential elderly care, residential care for people with intellectual disabilities and primary care). The identified essential themes of person-centered care can form a basis for person-centered care measurement. Theory/Methods : First, an explorative literature review and two expert focus groups were conducted. In the focus groups experts reflected on existing measures for person-centered care as identified in the literature review. The two main conclusions of the focus groups were: 1) the validity of the existing measures is questionable, and 2) existing instruments are measures top-down, without involving the key stakeholders. Based on these two conclusions, we decided to firstly focus on the identification of essential themes of person-centered care, according to the key stakeholders. A total of 44 narrative interviews were done. These were done in 2 primary care and 2 residential practices: clients (N=15), their relatives (N=11) and professional caregivers (N=18). A semi-structured topic list was used during the interviews. All interviews were fully transcribed and subsequently fragmented. A codebook was developed to perform narrative analyses. The codes were related to themes, people, roles, place, time and judgements. Three other researchers independently coded the fragments. Narrative analysis focused on similarities, differences and patterns between codes. After coding, three researchers independently analyzed the results and reached consensus on the outcomes. These were then checked with the settings in which the interviews took place. Results : A total of 2,637 fragments in 44 interviews were coded. Five core themes were identified: Clear information, Respect & Understanding, Making your own choices, Holism and Professionalism. The core themes were recognized in the settings in which the interviews took place. Conclusion & Discussion : Five core themes of person-centered care were identified bottom-up from the narrative interviews with key stakeholders. These core themes will form the basis for the development of a measure. Lessons learned : - Involving different perspectives from key stakeholders in care settings is crucial to get a better understanding of what person-centered care means. - On the research method: Narrative research can be used to interview a wide range of people (from people with intellectual disabilities to academic schooled professionals) and is valuable to study the perspectives of people. Limitations : Though different perspectives and different settings were included in this research, we were not able to interview till saturation was reached. As such, it is needed to further validate the identified themes. Suggestions for future research : It would be very interesting to compare the five core themes identified by the key stakeholders with existing literature, and identify differences and similarities. References : 1- Scholl I, Zill JM, Härter M, Dirmaier J.An Integrative Model of Patient-Centeredness – A Systematic Review and Concept Analysis. PLoS ONE 2014;9(9):e107828. Available from: doi:10.1371/journal.pone.0107828
关键词：measurement ; person-centered care ; person-centeredness ; narrative ; measure
