AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

AMA Journal of Ethics. January 2016, Volume 18, Number 1: 40-44.
doi: 10.1001/journalofethics.2016.18.1.medu3-1601.

Medical Education

  • Print
  • |
  • View PDF

Patient- and Family-Centered Care: It’s Not Just for Pediatrics Anymore

Patient- and family-centered care can be promoted through collaboration and health literacy and including patient and family values in care plans.

Aaron M. Clay, RN, and Bridget Parsh, RN, MSN, EdD

Patient- and family-centered care (PFCC) is changing the way hospitals provide patient care, increasing staff satisfaction, decreasing costs, and improving patient outcomes [1, 2]. Although hospitals make unique, organization-specific PFCC principles, all of them tend to endorse similar core values by recognizing the importance of family members’ roles in individual patients’ health care experience, establishing relationships with and supporting patients and families, and helping patients discover how their own strengths and weaknesses influence their health and health care. When patients’ needs are prioritized, they engage in treatment and the treatments are more effective [1-4]. Hospitals where PFCC is part of the organizational culture find not only that patient, family, and staff satisfaction ratings significantly increase, but also that patients’ health outcomes improve [2, 5]. Implementation of PFCC is also correlated with a decrease in patients’ emergency department visits, faster recovery, and decreased utilization of health care resources [2, 6-7].

PFCC has become widespread throughout health care [6, 8-12]. The PFCC concepts of patient-physician collaboration and treating the patient as a whole person are not new. Fifteen years ago, the Institute of Medicine (IOM) semi-annual report, Crossing the Quality Chasm [8], included PFCC as an initiative to improve quality in the list of ten rules for redesigning health care [13]. The IOM report emphasized the need to involve patients in their own health care decisions, to better inform patients of treatment options, and to improve access to information [8]. PFCC provides a holistic approach to patient care, including psychological, spiritual, cultural, and emotional considerations that contextualize experiences of illness or injury and go beyond a focus on disease processes only [1].

The term “family-centered” does not remove control from competent patients to make decisions concerning their own health care [11]. Instead, this concept emphasizes that a patient’s health care decisions should be contextualized in terms of a patient’s broader life experiences. This term also recognizes the role a patient’s family members play in extended and at-home care planning and care giving.

As medical care continues to become more collaborative, with a focus on holistic care for patients and their sources of support, principles of PFCC are now commonly taught to medical residents [14, 15]. For example, to be recognized by the Magnet Recognition Program, developed by the American Nurses Credentialing Center, hospitals must implement family-centered care [16]. No longer just for pediatrics, patient- and family-centered care applies to patients of all ages and can be practiced in any health care setting and at any point in care delivery; the Joint Commission suggestions include providing discharge instructions that meet the patient’s needs, informing patients of their rights, and identifying patients’ dietary restrictions that affect treatment [1]. Giving patients control, customizing care according to patients’ needs and values, and providing information to patients and their loved ones are other IOM recommendations that promote PFCC [8].

Recognizing the importance of patients’ loved ones in patients’ health care experiences, clinicians try to work with patients and families to ensure their health and well-being in a mutually beneficial relationship [8, 11, 12]. Principles of PFCC include listening to families, facilitating choice, sharing information, and building confidence to participate in health care decision making [2, 11]. By implementing PFCC, clinicians benefit by gathering more information, improving follow-through, making efficient use of professional time, and decreased health care utilization [6, 9, 11].

Based on the latest research and guidelines [1, 4, 10, 14], these strategies for successful patient- and family-centered care are suggested:

  1. Communicate and collaborate. According to the Institute for Patient and Family Centered Care, the word “family” refers to two or more persons who are related in any way—biologically, legally, or emotionally. The patient defines who represents his or her family and the level of involvement each family member will have. Involve designated family members, or support individuals, in care discussions, making sure they are available for multidisciplinary rounds to discuss concerns, the health care plan, and progress, and encourage them to participate. Patients and family members can provide information missing from medical charts and can recognize and speak up about errors in care delivery [7].
  2. Promote health literacy. Patients who are—and whose family members are—unaware of potential adverse effects or benefits of medications prescribed have poor compliance [17]. Providing information in terms patients and family members can understand and encouraging families to participate in the care of their loved ones can result in improved patient outcomes [18, 19]. Take time to understand any influences of language, health literacy, or social, educational, or cultural factors on patients or families. Use “teach backs” and “show backs,” in which patients or family members restate information provided by clinicians or display newly taught skills to increase understanding and decrease confusion [20]. This practice gives the care team the opportunity to discern and correct errors or misunderstandings [1, 19].
  3. Include the patient and family. Work toward a professional, respectful relationship with your patients, incorporating their preferences and values in care goals and plans. Identify and address patient communication needs promptly, such as assistance for family members whose preferred language is not English or who have sensory or communication impairments. Disclose and acknowledge any medical errors promptly, per your facility’s policy. When making clinical decisions, consider individual patient values along with possible language barriers, cultural issues, health literacy, and other factors [21, 22].

Prominent organizations including the Institute of Medicine (IOM), the Institute for Patient- and Family-Centered Care (IPFCC), the Institute for Healthcare Improvement (IHI), the American Academy of Pediatrics (AAP), and the American College of Emergency Physicians have endorsed PFCC practices, helped to define PFCC, and illustrated the importance of incorporating patients and their loved ones into health care discussions and decisions [8-12]. PFCC improves quality and safety of care, chronic disease management, and patient satisfaction; reduces hospitalizations and medical errors; and lowers costs [1, 2, 6, 11, 17, 21].



References

  1. Joint Commission. Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: Joint Commission; 2010. http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf. Accessed November 24, 2015.
  2. Small DC, Small RM. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model. Online J Issues Nurs. 2011;16(2):2.
  3. University of California, San Francisco Benioff Children’s Hospital. Family centered care. https://www.ucsfbenioffchildrens.org/about/family_centered_care/index.html. Accessed November 24, 2015.
  4. American Hospital Association. Strategies for leadership: patient- and family-centered care. http://www.aha.org/advocacy-issues/quality/strategies-patientcentered.shtml. Accessed November 24, 2015.
  5. DiMatteo MR. The role of the physician in the emerging health care environment. West J Med. 1998;168(5):328-333.
  6. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229-239.
  7. Aronson PL, Yau J, Helfaer MA, Morrison W. Impact of family presence during pediatric intensive care unit rounds on the family and medical team. Pediatrics. 2009;124(4):1119-1125.
  8. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
  9. Institute for Patient- and Family-Centered Care. Frequently asked questions. http://www.ipfcc.org/faq.html. Accessed November 24, 2015.
  10. Herrin J, Harris KG, Kenward K, Hines S, Joshi MS, Frosch DL. Patient and family engagement: a survey of US hospital practice [published online ahead of print June 16, 2015]. BMJ Qual Saf. doi:10.1136/bmjqs-2015-004006.
  11. Committee on Hospital Care; Institute for Patient- and Family-Centered Care. Patient- and family-centered care and the pediatrician’s role. Pediatrics. 2012;129(2):394-404.
  12. American College of Emergency Physicians. Patient- and family-centered care and the role of the emergency physician providing care to a child in the emergency department. June 2006. https://www.acep.org/Clinical---Practice-Management/Patient--and-Family-Centered-Care-and-the-Role-of-the-Emergency-Physician-Providing-Care-to-a-Child-in-the-Emergency-Department/. Accessed November 12, 2015.
  13. Institute of Medicine, 61-62.
  14. Philibert I, Patow C, Cichon J. Incorporating patient- and family-centered care into resident education: approaches, benefits, and challenges. J Grad Med Educ. 2011;3(2):272-278.
  15. Picker Institute. Patient-centered care: the road ahead. March 2013. http://www.ipfcc.org/pdf/Patient-Centered%20Care%20The%20Road%20Ahead.pdf. Accessed December 4, 2015.
  16. American Nurses Credentialing Center. Magnet Recognition Program: a program overview. 2011. http://nursecredentialing.org/Documents/Magnet/MagOverview-92011.pdf. Accessed November 25, 2015.
  17. Ciufo D, Hader R, Holly C. A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centred care. Int J Evid Based Healthc. 2011;9(4):362-387.
  18. Joint Commission, Advancing Effective Communication, 14.
  19. Joint Commission. “What did the doctor say?” : Improving health literacy to protect patient safety. 2007. http://www.jointcommission.org/assets/1/18/improving_health_literacy.pdf. Accessed November 24, 2015.
  20. Institute for Healthcare Improvement. Always use teach back! http://www.ihi.org/resources/Pages/Tools/AlwaysUseTeachBack!.aspx. Accessed November 24, 2015.
  21. Reed P, Conrad DA, Hernandez SE, Watts C, Marcus-Smith M. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington state. BMC Fam Pract. 2012;13:120.
  22. O’Kane M. Medical homes delivering on promises. Mod Healthc. 2014;44(44):39.

Further Reading

  • Conway J. Patients and families: Powerful new partners for health care and for caregivers. Healthcare Executive. 2008;23(1):60-62. http://www.cha.com/pdfs/Quality/Tools and Resources/conwaypatientsandfamilieshcexecutivejan08.pdf. Accessed November 24, 2015.

  • Fredericks S, Lapum JL, Hui G, Cockwell D. Applying patient-centred care to surgical intervention. Br J Cardiac Nurs. 2015;10(4):170-174.

  • Lee YY, Yin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient-physician relationships and health outcomes. Soc Sci Med. 2010;71(10):1811-1818.

  • Rothman PB. At the center of care. Hopkins Medicine Magazine. February 1, 2013. http://www.hopkinsmedicine.org/news/publications/hopkins_medicine_magazine/archives/winter_2013/at_the_center_of_care. Accessed November 24, 2015.

  • Selimen D, Andsoy II. The importance of a holistic approach during the perioperative period. AORN J. 2011;93(4):482-490.

  • Taylor A. Person-centred care in practice. Br J Midwifery. 2015;23(5):350-355.

  • Tzelepis F, Rose SK, Sanson-Fisher RW, Clinton-McHarg T, Carey ML, Paul CL. Are we missing the Institute of Medicine’s mark? A systematic review of patient-reported outcome measures assessing quality of patient-centred cancer care. BMC Cancer. 2014;14:41.

Aaron M. Clay, RN, is a registered nurse in the neonatal intensive care unit at University of California Davis Children’s Hospital.

Bridget Parsh, RN, MSN, EdD, is an associate professor in the School of Nursing at California State University, Sacramento.

Acknowledgment

Many thanks to Sacramento State for supporting nursing scholarship.

Moving Past Individual and “Pure” Autonomy: The Rise of Family-Centered Patient Care, January 2016

Evidence-Based Design: Structuring Patient- and Family-Centered ICU Care, January 2016

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.