Qualitative analysis of US Department of veterans affairs mental health clinician perspectives on patient-centered care

Dobscha, Steven K.; Cromer, Risa; Crain, Aysha; Denneson, Lauren M.

doi:10.1093/intqhc/mzw028

Cited by 14 publications

(8 citation statements)

References 16 publications

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“…Patient-centered care is often characterized by shared patient-clinician power and responsibility, a biopsychosocial orientation, patient and clinician humanity, and a therapeutic alliance [20]. True patient-centered care has been thought to be difficult to implement in mental health settings, where clinicians historically have had role expectations in which the patient is viewed as someone to “protect” and for whom the clinician is “responsible” [21-23]. We saw similar themes in this study.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Denneson¹,

Cromer²,

Williams³

et al. 2017

J Med Internet Res

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BackgroundAs part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings.ObjectiveThe aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care.MethodsWe conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process.ResultsOpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes.ConclusionsOur findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation.

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Section: Discussionmentioning

confidence: 99%

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Denneson¹,

Cromer²,

Williams³

et al. 2017

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

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“…Similar barriers in implementing patient-centered outcomes in nephrology and other medical specialties have been previously identified, including rigid regulatory structures, disease-centric incentivization schemes on the basis of laboratory parameters (e.g., Kt/V and hemoglobin), resource constraints, emphasis on biochemical targets and technical procedures, and lack of mechanisms for patients to communicate their priorities (10,(43)(44)(45)(46). A study in mental health professionals also found that clinicians were concerned about being held accountable for managing the array of needs and goals that a patient may have (47). Our findings add to existing literature by highlighting some of the unique challenges in the context of hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Nephrologists’ Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis

Tong

Winkelmayer

Wheeler

et al. 2017

CJASN

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Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader quality of life outcomes in a care setting that is technically demanding and driven by biochemical targets. Identifying critical patient-important outcomes and mechanisms for integrating them into practice may help to deliver patient-centered care in hemodialysis and other chronic disease settings.

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“…A 5-year postimplementation study of the MLMS project showed that a majority of providers found reading life stories a valuable use of clinical time and helped them provide more personalized, patient-centered care ( 3 ). Acknowledging the patient as a holistic individual empowers that patient to play an active role in their care ( 4 – 6 ) and has been shown to improve patient experience, patient-provider trust, and health outcomes ( 5 , 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

What Do You Want Us to Know?: Learning From Life Stories to Improve Veterans’ Healthcare Experiences

Nguyen

Khetarpal

et al. 2022

Journal of Patient Experience

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My Life My Story (MLMS) is a national Veterans Health Administration (VA) life story interview program that aims to provide more humanistic care for veterans by focusing on the patient as a person. Our project took place at the Pittsburgh VA Healthcare System and had 3 main goals: (1) describe themes that emerge in MLMS interviews from the prompting question, what do you want your healthcare provider to know about you?; (2) identify topics of importance to veterans and suggest ways for healthcare providers to explore them; and (3) foster a culture at the Pittsburgh VA that places not only the health but also the personal triumphs, hardships, and aspirations of veterans at the center. Veterans provided verbal consent to have their previously recorded stories used in this study. Stories were coded and then analyzed for patterns and themes. A total of 17 veterans participated in our study. Themes that emerged from the stories include (1) Early Hardships; (2) Economic Disadvantage; (3) Polaroid Snapshots; (4) Around the World; (5) Haunted by Combat; (6) Life-altering Moments; (7) Homecoming; (8) Romantic Beginnings & Obstacles; (9) Inequity across Gender & Race; and (10) Facing Mortality. This study's findings underscore the need to address the traumas associated with military service, as well as the challenges faced with re-integration into civilian life, when working with veterans. The MLMS interviews explored in this study can help clinicians identify topics of importance to veterans, strengthen their relationships with their patients, and improve the care that veterans receive.

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Qualitative analysis of US Department of veterans affairs mental health clinician perspectives on patient-centered care

Abstract: If patient-centered care is to be practiced fully in mental health settings, healthcare institutions need to develop multimodal strategies to enhance clinician-clinician and clinician-patient collaborations to promote and support a focus on discovery and shared accountability for outcomes.

Cited by 14 publications

References 16 publications

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Nephrologists’ Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis

What Do You Want Us to Know?: Learning From Life Stories to Improve Veterans’ Healthcare Experiences

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