Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review

Abstract

Background Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance. Aims This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders. Methods Following the iterative stages of the Arksey and O’Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data. Findings One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle. Conclusions This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.

WITHDRAWN: Examining Substance Use Services and Treatment Barriers and Needs among People with Lived Experience (PWLE) in Ontario, Canada.

“…This can be achieved by creating opportunities for client engagement to allow their needs and concerns to be heard by empathetic and enthusiastic service providers who can work with them towards reaching their goals, and who can assess the client's current state of readiness on an ongoing basis by providing frequent one-on-one needs assessments [61]. Such a patient-centered, collaborative approach would allow clients' voices and needs to be paramount in their treatment plan, which would increase willingness for recovery and ultimately the success of treatment [61][62][63][64]. Service providers should actively seek out, employ and collaborate with PWLE who are experientially quali ed to help design and deliver client-centred substance use programs.…”

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

“…Beyond providing further understanding of the patient-centered aspects of iOAT, this study illustrates how PCC might be experienced in substance use treatment more broadly. This is particularly timely given increasing interest in the role of PCC for improving the quality of substance use treatment [29][30][31][32][33]. To our knowledge, few studies [33] have comprehensively explored the domains of PCC in substance use treatment according to existing conceptual frameworks [22][23][24][25][26][27][28]32].…”

“…All interviews took place in a private research office that was independent of the clinical site. In-depth interviews (conducted by author KM) used open-ended questions to capture participants' experiences in iOAT as they broadly related to the four core domains of PCC: (1) individualized care tailored to clients' unique needs, values and preferences; (2) a holistic or bio-psycho-social perspective; (3) an enhanced therapeutic relationship; and (4) client empowerment and participation in treatment decisions [22][23][24][25][26][27][28]32]. Interviews lasted an average of 48 min (range 18-91 min) and participants received a $20 honourarium for their time.…”

Expanding Access to Medications for Opioid Use Disorder: Program and Policy Approaches from Outside the Veterans Health Administration

“…A recent scoping review describes four key elements of patient-centered care defined by people with drug use disorders: (1) a therapeutic alliance (i.e., empathy and non-judgmental clinical care); (2) shared-decision making; (3) individualized care; and (4) holistic care (i.e., integration of substance use, health, and psychosocial services). 9 Unfortunately, most MOUD-treatment delivery systems and policies are not grounded in person-centered approaches. We highlight two exceptions, which reflect patient centered philosophies or tactics: the Medication First (Med First) Model 10 and culturally specific MOUD delivery design for Black patients with OUD.…”