Care planning for long‐term conditions – a concept mapping

Abstract

Objective This article focuses on approaches within clinical practice that seek to actively involve patients with long-term conditions (LTCs) and how professionals may understand and implement them. Personalized care planning is one such approach, but its current lack of conceptual clarity might have impeded its widespread implementation to date. A variety of overlapping concepts coexist in the literature, which have the potential to impair both clinical and research agendas. The aim of this article is therefore to explore the meaning of the concept of care planning in relation to other overlapping concepts and how this translates into clinical practice implementation.Methods Searches were conducted in the Cochrane database for systematic reviews, CINHAL and MEDLINE. A staged approach to conducting the concept mapping was undertaken, by (i) an examination of the literature on care planning in LTCs; (ii) identification of related terms; (iii) locating reviews of those terms. Retrieved articles were subjected to a content analysis, which formed the basis of our concept maps. (iv) We then appraised these against knowledge and experience of the implementation of care planning in clinical practice.Results and Conclusions Thirteen articles were retrieved, in which the core importance of patient-centredness, shared decision making and self-management was highlighted. Literature searches on these terms retrieved a further 24 articles. Our concept mapping exercise shows that whilst there are common themes across the concepts, the differences between them reflect the context and intended outcomes within clinical practice. We argue that this clarification exercise will allow for further development of both research and clinical implementation agendas. 605

Care planning for consumers on community treatment orders: an integrative literature review

“…Increased stakeholder participation (of workers, consumers and carers) during mental health tribunals was recommended to enhance decision-making related to CTOs [24], with a particular focus on promoting consumer participation in early stages of CTO implementation [48]. Shared decision-making (SDM) is a core concept in care-planning and builds on person centeredness by promoting mutual expertise and determining the individuals ‘preferred role in the decision-making process’ [19]. In mental health care, SDM is often referred to in the context of supporting consumers’ to make informed decisions related to medication [72, 73].…”

“…Identified principles of good practice included: taking a human rights perspective (being aware of peoples’ right to self-determination); being transparent regarding CTO goals and purposes and linking these to treatment goals; providing quality services (including continuity of care and evidence-based interventions); facilitating involvement of consumers and their carers’ in the CTO process and development and use of direct practice skills (including linking with support staff and development of advanced interpersonal skills) [24]. Similarly, Lehssier et al [19] emphasised the need for case managers to have advanced practitioner skills, such as SDM and motivational interviewing.…”

“…In summary, though case management has been used in practice for several decades, there remains a lack of conceptual clarity of what personalised care planning is [19] and lack of evidence regarding its effectiveness [4, 20]. In mental health care, compulsory care further challenges concepts of personalised care planning.…”

Care planning for long term conditions in primary care: indicators of embeddedness

“…In parallel to these kinds of practice implementation efforts, researchers have begun to develop the conceptual clarity of care planning [7,12]. A sense of coherence being a pre-requisite to successful implementation, these combined efforts are contributing to the translation of care planning policy into practice in the broadest sense.…”

“…Care planning is a systematic way of operationalizing person-centered care for long-term conditions and involving people in their care in order to provide support and guidance for self-management [12][13][14]. It requires the 4 following inter-dependent elements: 1) engaged and informed patients; 2) healthcare professionals committed to partnership working; 3) facilitative organisational structures & 4) supportive commissioning processes [15].…”