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Understanding the person, engagement in decision‐making and promoting the care relationship are key elements of effective person-centredness in community care

Wilberforce M, Challis D, Davies L, et al.  Person-centredness in the community care of older people: A literature-based concept synthesis  International Journal of Social Welfare. 2017; 26(1) : 86-98.

Review question

• What are effective person-centred practices for the care of older adults in a community setting?

Background

• The term person-centredness is defined as high-quality care that is flexible and responsive to the needs of the clients, as wells as by recognizing that each client is unique.
• For older adults, person-centredness is often linked to positive health outcomes and improved satisfaction with care. Despite this, a coherent understanding of person-centredness is somewhat limited.
• This synthesis aims to identify the attributes that can be used for designing interventions, training, or other ‘actionable’ practices to provide person-centred care for older adults in a community setting.

How the review was done

• A detailed search of a number of electronic databases without a noted date restriction was conducted. Studies that focused on descriptions of attributes of person-centred care for older adults in community settings were included in the search.
• Of the studies identified, 51 documents were included in the review after assessments for eligibility, with 79 additional documents contributing to further elaboration of person-centred care practices.
• The review was funded by the National Institute for Health Research. 

What the researchers found

• Several interpretations of person-centred care were identified, including understandings from general medical, nursing, dementia, social care and rehabilitation perspectives.
• Based on these various interpretations, 12 attributes were found that can be grouped into three broad categories:
• understanding the person (including understanding the personal experience of illness/disability; knowing the different dimensions of life requiring support; understanding the person’s values and preferences in care; and knowing what is important to the person’s identity and wellbeing);
• engaging in decision-making (including involving the person in decision-making processes; their wishes shaping decisions and care plans; flexible care services being tailored to individual preferences; information and options being shared in a clear format); and
• promoting a care relationship (including friendly, caring and respectful interactions; continuity and coordination in care relationships; positive attitude to person’s capabilities and roles; and reciprocity in care relationship).
• Examples of person-centred care practices corresponding to these attributes include the establishment of care goals that are aligned with an individual’s values and identity, and open-ended communication. Other examples include person-centred planning and establishing a ‘working alliance’ relationship built on mutual respect between the care professional and the older adult.

Conclusion

• Based on the synthesis of relevant studies, different interpretations of person-centredness were found.
• This illustrates that there is no ‘one-size fits all approach’ to person-centred care.