A Capabilities Approach to Person-Centered Care: Response to Open Peer Commentaries on “Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care”

Abstract

This is an electronic version of an article published in American JournalOur suggestion that the aspects of healthcare quality associated with 'person-centered care' can be understood as a matter of health services and staff recognising and cultivating a subset of capabilities that we called 'person-al'(Entwistle and Watt 2013) attracted a diverse set of open peer commentaries. Taken together, we think these commentaries highlight the strong potential of the guiding idea to illuminate and help address a range of issues of ethical concern across diverse healthcare domains. They also offer some helpful suggestions for the further development and investigation of applications of capabilities thinking in relation to person-centered care and healthcare delivery more generally.Several commentaries identify specific concerns about, and challenges for, our approach. Some of the concerns rely on interpretations of our position that we do not share. They prompt us to try to clarify some key points before responding briefly to some of the suggestions about additional implications and applications.

Feeling Respected as a Person: a Qualitative Analysis of Frail Older People’s Experiences on an Acute Geriatric Ward Practicing a Comprehensive Geriatric Assessment

“…Rather they were limited in their cognitive capacities, restricting and preventing optimal communication and understanding, which was clinically assessed by the ward staff. Therefore, the term to describe the care they received is not a person-centered approach, but rather an alternative term of “person-supportive care” as suggested by Entwistle et al [35]. According to Munthe et al [36], person-centered care is intended to empower and liberate patients.…”

“…A CGA should be used to assess, treat, and plan future care with frail older people [8,37,38]. Entwistle et al [35] found that staff must understand patient goals and capabilities, despite the fact that medical and health care policies may occasionally promote initiatives that overlook that patients are people. An earlier study warned health professionals [38] that if they do not understand patient preferences, overlook or misinterpret the person, the consequences could be as harmful as misdiagnosing a disease.…”

Addressing preference heterogeneity in public health policy by combining Cluster Analysis and Multi-Criteria Decision Analysis: Proof of Method

“…Or to look forward and explore the relationship with some future outcome or behavior, probably also via regression analysis. But we argue that neither of these explorations is appropriate when it involves reducing the preferences of a person, or group of persons, to a set of predictive or predictor variables, since this undermines the fundamental personhood of the preference-bearer [ 50 ].…”

Nursing Care Ethical Implications Regarding Chronic Patients at Hospital Discharge

“…Although there are many definitions of "patient-centered care", it has been broadly conceived as "providing care that is respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions" [17]. This concept is framed within the "person-centered care" concept, as it considers that planning care strategies not only affects patients' health issues, but also their abilities to cope with them [18].…”