User centred care GPs’ perspective CAPHRI 02-04-12 Prof Trudy van der Weijden Dept General...
-
Upload
raven-ferebee -
Category
Documents
-
view
213 -
download
0
Transcript of User centred care GPs’ perspective CAPHRI 02-04-12 Prof Trudy van der Weijden Dept General...
User centred careGPs’ perspectiveCAPHRI 02-04-12
Prof Trudy van der WeijdenDept General PracticeProgramme leader CAPHRI “Implementation of evidence”
School for Public Health and Primary Care CAPHRI
Content
• Definitions• User-centred research (evidence)• User-centred knowledge (guidelines)• User-centred care (performance)• Key messages
School for Public Health and Primary Care CAPHRI
Key messages
- User-centred care has many faces- Providers and patients are users of
knowledge, new era of democratising knowledge
- Collective and individual preferences- From provider- to dialog-driven care
School for Public Health and Primary Care CAPHRI
Content
• Definitions• User-centred research (evidence)• User-centred knowledge (guidelines)• User-centred care (performance)• Key messages
School for Public Health and Primary Care CAPHRI
Definitions user-centred care, patient centredness
• Respect, autonomy, dignity • Accessible, confidential, continuity of
care, holistic, emotional supportive• Care is responsive to patient
preferences, needs, and values, ensuring that patient values guide all clinical decisions
IOM, WHO, Picker Institute, Berwick, Mead, NPCF etc
School for Public Health and Primary Care CAPHRI
Definition user-centred care
– multidimensional concept– difficult to grasp– difficult to measure– easy to acknowledge
High radiation doses?
Low radiation doses?
Early-stage prostate cancer
Stalmeier PF, et al. J Clin Oncol
2007;25:3096-100.
School for Public Health and Primary Care CAPHRI
“All I deliver is user-centred care!”
• Videos of consultations– 25 patients early-stage prostate cancer– 10 radiation-therapists
• Mean 48 minutes (± 16 min)• >1 option discussed with 10 patients
(option no radiation 0x)• “Understood?” after 42m.,
“Questions?” after 45m.Pieterse A, et al. Patient Education and Counseling
2011;85:e251–e259
School for Public Health and Primary Care CAPHRI
Participation ladder (Arnstein 1969)D
eg
ree o
f co
ntr
ol
Patients in control
Acting together
Deciding together
Consultation
Information
School for Public Health and Primary Care CAPHRI
Content
• Definitions• User-centred research (evidence) • User-centred knowledge (guidelines)• User-centred care (performance)• Key messages
School for Public Health and Primary Care CAPHRI
Participation in research project
It’s LiFe
Jos Donkers. “Former director Marriott HotelsInt, in 1978 diagnosed with severe COPD.”
Ina van Opstal. “I work for the Diabetes Association as a diabetes experiential expert, and health care advisor.”
School for Public Health and Primary Care CAPHRI
Content
• Definitions• User-centred research (evidence)• User-centred knowledge (guidelines)• User-centred care (performance)• User-centred change (implementation)• Key messages
School for Public Health and Primary Care CAPHRI
Patient participationin guideline development
patient
School for Public Health and Primary Care CAPHRI
User-centred knowledge
• Guidelines new style:– All stakeholders involved (patients!)– Declaration of interests– Short: < 10-15 recommendations – Easy accessible for patients– All relevant evidence – Patient decision aids linked to preference-
sensitive recommendations Van der Weijden T, et al. J Clin Epid 2012 Jan
School for Public Health and Primary Care CAPHRI
Content
• Definitions• User-centred research (evidence)• User-centred knowledge (guidelines)• User-centred care (performance)• Key messages
School for Public Health and Primary Care CAPHRI
Medical decision makingGuideline:
Interpretation evidence
Patient: co-morbidity
genetic predispositionpreferences
Setting:expertise
organisation financial
conditions
Sackett BMJ 1996
School for Public Health and Primary Care CAPHRI
Paternalism Informed patient
Information-transfer
Deliberation clinician patient
Decision making
clinician patient
School for Public Health and Primary Care CAPHRI
SDM
Paternalism SDM Informed patient
Information-transfer
Deliberation clinician patient
Decision making
clinician patient
clinician and patient
clinician and patient
Charles et al. Soc Sci Med 1999;49:651-61.
Elwyn G et al. Med Decis Making 2010;30:701e11.
School for Public Health and Primary Care CAPHRI
Koelewijn et al. Prev Med 2010;50;35
Koelewijn et al. CMAJ 2009;181:E267
Koelewijn et al. BMC Health Serv Res 2008;8;9
IMPALA study
School for Public Health and Primary Care CAPHRI
User-centred care GPs role
Moser A et al. Pat Educ Couns 2010;78:365-71.
School for Public Health and Primary Care CAPHRI
Key messages
- User-centred care has many faces- Providers and patients are users of
knowledge, new era of democratising knowledge
- Collective and individual preferences- From provider- to dialog-driven care
School for Public Health and Primary Care CAPHRI
Uncertainty
“Uncertainty creeps into medical practice through every pore. Whether a physician is defining a disease, making a diagnosis, selecting a procedure, observing outcomes, assessing probabilities, assigning preferences, or putting it all together, he is walking on very slippery terrain. It is difficult for nonphysicians, and for many physicians, to appreciate how complex these tasks are, how poorly we understand them, and how easy it is for honest people to come to different conclusions.”
Eddy DM. Health Aff (Millwood) 1984;3:74–89.
School for Public Health and Primary Care CAPHRI
Review Cochrane Library
• Knowledge (options, pros cons)• Involvement in decision• Preference => decision• Patient adherence • Invasive treatments • Health• Anxiety / consultation length
Stacey D, et al. Cochrane Library 2011.
==
≈
School for Public Health and Primary Care CAPHRI
Three sources of uncertainty
• probability (the risk of a future event)• ambiguity (uncertainty about the
strength or quality of risk estimates)• complexity (uncertainty arising from
the complexity of the information on risk, depends on personal judgments)
Han PK, et al. Med Dec Making 2011 Jan