A Person-Centered Communication and Reflection Model: Sharing Decision-Making in Chronic Care

Abstract

Shared decision making (SDM) is regarded as an ideal in chronic illness care but is difficult to implement in practice. Communication and reflection play an important role and need further investigation. Using grounded theory, we studied patient-provider interaction in a difficult and advanced area: managing poorly controlled diabetes. A person-centered communication and reflection model was developed, identifying SDM in chronic care to be a question of professionals gaining insight into patients' decisions, rather than the opposite. The model reveals important choices in communication and reflection, which were decisive for whether SDM was achieved or not. SDM involved co-creating person-centered knowledge: concrete evidence which empowered patients and professionals in problem solving. Although further testing is required, the general tenets of the model are expected to be applicable across chronic conditions. Findings indicate that SDM in chronic illness care requires innovation in current approaches to decision making and problem solving.

A qualitative study on the role of patient–nurse communication in acute cardiac care

“…Most activities in a CCU are disease-oriented, focused on the patients' symptoms, test results and treatments. The same phenomenon was noted in chronic care, where nurses got stuck in disease-oriented activities, instead of starting from the patient's perspective, and focusing on their understanding of the situation [14]. Workload and lack of time is frequently cited as an argument for not entering into person-centered communication.…”

“…Studies in chronic care indicate that person-centered communication is necessary for shared decision making and to empower patients to take responsibility for their own health [14]. In person-centered communication, the patient's perspective is the foundation for the dialogue, and social, psychological and emotional factors are acknowledged as being equally important as somatic symptoms [2,3,9].…”

Self-reflective talk in group counselling

“…First, as an activity of the counsellor, reflection is understood as practices that counsellors use to mirror, dismantle and conceptualize their clients' talk (Brownlee et al, 2009;Miller and Rollnick, 2012;Zoffmann et al, 2008). Second, as an activity of the client, it consists of practices such as autonomous clarifications and reassessments of one's own statements (Zoffmann et al, 2008), or disagreements and explanations (Zapata-Rivera and Greer, 2003). Third, reflection can be understood as joint action of both the counsellor and the client.…”

Determinants of Successful eHealth Coaching for Consumer Lifestyle Changes: Qualitative Interview Study Among Health Care Professionals (Preprint)

“…including both web-based and non-webbased components in the health coaching [2]. Earlier studies on the consultation process revealed that health professionals only have access to a patient's reflections on difficult, personal and relevant subjects in relation to his/her health if the HCP manages to establish an empathic relationship [19].…”