What is Important to Older People with Multimorbidity and Their Caregivers? Identifying Attributes of Person Centered Care from the User Perspective

Abstract

Introduction: Health systems are striving to design and deliver care that is ‘person centred’—aligned with the needs and preferences of those receiving it; however, it is unclear what older people and their caregivers value in their care. This paper captures attributes of care that are important to older people and their caregivers. Methods: This qualitative descriptive study entailed 1–1 interviews with older adults with multimorbidity receiving community based primary health care in Canada and New Zealand and caregivers. Data were analyzed to identify core attributes of care, important to participants. Findings: Feeling heard, appreciated and comfortable; having someone to count on; easily accessing health and social care; knowing how to manage health and what to expect; feeling safe; and being independent were valued. Each attribute had several characteristics including: being treated like a friend; having contact information of a responsive provider; being accompanied to medical and social activities; being given clear treatment options including what to expect; having homes adapted to support limitations and having the opportunity to participate in meaningful hobbies. Conclusions: Attributes of good care extend beyond disease management. While our findings include activities that characterize these attributes, further research on implementation barriers and facilitators is required.

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

“…Policies shaping the organisation of care delivery are also shown to have a disruptive impact on the patient consultation by creating a care context 'structured and incentivized to support short clinical interactions and disease focused care' [109]. This approach is not only at odds with the principles of patient-centred care endorsed by health systems (even at the national level), but also with the everyday reality of clinical practice where increased patient complexity requires more, not less time and interaction with the GP.…”

A client-centered approach in home care for older persons – an integrative review

“…In home care, motivation and commitment to one's own care strengthens the individual performance and resources of the older person [29][30][31][32][33]. Participation in care management increases the sense of involvement and wellbeing [29,[34][35][36][37]. Motivation is influenced by personality [38], cultural background [39], cognitive abilities, age and resources to participate, marital status and positive guidance [35].…”

“…The client's knowledge, need of services, values, beliefs, and cultural background are incorporated into the planning and delivery of care [33,37,39]. Active involvement in the setting of goals is evidently one of the essential steps towards empowering older people [24,29,30,35,37,38]. Participation in medication, care planning and scheduling, and goal setting increases the client's sense of involvement [30][31][32][35][36][37].…”

“…Delivery and organization of services. In the delivery and organization of services [27,[30][31][32][33][34]37,39,45] clientcentered services are implemented in a highly coordinated, predictable, accessible, flexible and multidisciplinary manner in the provision of social and health care. Resource allocation and support within services also affect the organization of client-centered services, for example the need for small care teams [34,37,46,48], involving f a physician, geriatrician or a general practitioner in the provision of services, use of care technology in the delivery of services as well as the involvement of private and public sectors [39].…”

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers

“…Not surprisingly, the relational aspects of care were paramount for people and their caregivers. These factors (which were mostly relational in nature) included feeling heard and comfortable during care interactions, knowing what to expect, having someone to count on, feeling safe and independent and easily accessing health and social care that was meaningful (Kuluski et al 2019). Provider activities were identified as being key enablers of needs being met, such as taking the time to listen intently and answer healthcare and non-healthcare-related questions, explaining why certain treatments or medications are being recommended and that changes in symptoms may not happen right away and providing a phone number of a provider who is available to answer questions, if any, arise.…”