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      Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care

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          Abstract

          Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons . This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain.

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          Most cited references58

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          Patient-centredness: a conceptual framework and review of the empirical literature.

          A 'patient-centred' approach is increasingly regarded as crucial for the delivery of high quality care by doctors. However, there is considerable ambiguity concerning the exact meaning of the term and the optimum method of measuring the process and outcomes of patient-centred care. This paper reviews the conceptual and empirical literature in order to develop a model of the various aspects of the doctor-patient relationship encompassed by the concept of 'patient-centredness' and to assess the advantages and disadvantages of alternative methods of measurement. Five conceptual dimensions are identified: biopsychosocial perspective; 'patient-as-person'; sharing power and responsibility; therapeutic alliance; and 'doctor-as-person'. Two main approaches to measurement are evaluated: self-report instruments and external observation methods. A number of recommendations concerning the measurement of patient-centredness are made.
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            Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues.

            The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues.
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              Freedom of the Will and the Concept of a Person

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                Author and article information

                Journal
                Am J Bioeth
                Am J Bioeth
                uajb
                The American Journal of Bioethics
                Taylor & Francis
                1526-5161
                1536-0075
                17 July 2013
                August 2013
                : 13
                : 8
                : 29-39
                Affiliations
                University of Aberdeen
                University of York
                Author notes
                Address correspondence to Vikki A. Entwistle, Professor of Health Services Research and Ethics, Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, United Kingdom. E-mail: vikki.entwistle@ 123456abdn.ac.uk

                A short presentation of this work was made at the 2011 conference of the Human Development and Capabilities Association in Den Haag, Netherlands. The authors are grateful for comments from participants at that meeting and also for particularly helpful feedback on draft versions of this article from Alan Cribb, John Owens, and Stephen Buetow.

                Article
                10.1080/15265161.2013.802060
                3746461
                23862598
                38e26787-be0f-43db-ae8d-6402e8bbb309
                © Vikki A. Entwistle and Ian S. Watt

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Target Article

                Ethics
                person-centered care,patient-centered care,professional-patient relations,capabilities approach,ethics,quality of care

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