Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review

Abstract

Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty.Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results:The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned.Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources.Tomaselli et al. Person-Centered Care and Relational EthicsThis distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.

The psychological burden of waiting for procedures and patient‐centred strategies that could support the mental health of wait‐listed patients and caregivers during the COVID‐19 pandemic: A scoping review

“…Addressing emotions is a recognized component of person‐centred care and includes eliciting or listening to concerns, expressing empathy, acknowledging hearing and understanding concerns, validating concerns by noting they are normal or common, and offering strategies to manage emotions or referring individuals to helpful information or services 85,86 . Person‐centred care has been associated with increased knowledge, skill, quality of life and satisfaction with the health‐care system; and decreased stress and anxiety among patients and caregivers across primary, emergency, acute and intensive care settings 87,88 . A related concept is that of safety‐netting, where clinicians explicitly address uncertainty by providing advice on what to do and who to contact if symptoms should arise, and subsequently monitoring for symptoms and/or arranging follow‐up care 89 .…”

“…Person-centred care has been associated with increased knowledge, skill, quality of life and satisfaction with the health-care system; and decreased stress and anxiety among patients and caregivers across primary, emergency, acute and intensive care settings 87,88. A related concept is that of safety-netting, where clinicians explicitly address uncertainty by providing advice on what to do and who to contact if symptoms should arise, and subsequently monitoring for symptoms and/or arranging follow-up care 89.…”

From a View of the Hospital as a System to a View of the Suffering Patient

“…Practically, since findings revealed two separate realities, one reality at the system level and one reality at the patient level, we suggest interventions to consolidate these realities into one through strengthening the SoC of DMBs and enhancing their capacity to shift between the system view and the patient view while coping with the high-stress, complex environment of the hospital. A higher SoC will facilitate decision making that considers emotional needs and experiences of patients, resulting in improved outcomes (7,32,62).…”

“…PCC entails emotional support, physical comfort, communication, education, continuity of care, coordination of care, family involvement, and access to care (4)(5)(6). Moreover, PCC dimensions include patientclinician concordance, meeting patient expectations, integrating patients within the environment, viewing a patient as a person, conducting dialogue and interaction, sharing patient experience, and documentation of the patient's narrative (7). PCC fosters healing relationships; responds to patients' emotions; engages patients in informed and collaborative decision making; and seeks to provide each patient with care she values (8,9).…”

“…PCC fosters healing relationships; responds to patients' emotions; engages patients in informed and collaborative decision making; and seeks to provide each patient with care she values (8,9). PCC leads to improved health outcomes through improved patient safety, higher patient trust in physicians, higher adherence, better recuperation, fewer readmissions, and higher quality of life (7,8,(10)(11)(12).…”