Systematic Conceptualization of Person Centered Medicine and Development and Validation of a Person-centered Care Index
Keywords:Person Centered Medicine, Conceptualization, Measurement, Metrics, Principles, Geneva Conferences, International Network of Person Centered Medicine, International College of Person Centered Medicine, People-centered Care, Instruments, Validation
AbstractBackground: A world-wide movement is emerging for person centered medicine and healthcare collaboratively developed by the International College of Person Centered Medicine and a number of global institutions through annual Geneva Conferences and International Congresses as well as scholarly publications. While frequently quoted definitional note have been advanced through this maturational process, efforts are needed to conceptualize and measure systematically person-centered care.Objectives: These included the elucidation of the core concepts of person centered medicine and healthcare, the design of a prototype measuring instrument, and the study of its metric structure, acceptability, reliability and validity.Methods: The following methodological approaches were employed: A systematic review of the literature, consultation exercises with broad international panels composed of health professionals and representatives of patient and family organizations, and quantitative and qualitative data analyses.Results: The following key concepts underlying person centered medicine were elucidated: 1) Ethical Commitment, 2) Cultural Sensitivity, 3) Holistic scope, 4) Relational Focus, 5) Individualized Care, 6) Common Ground for Collaborative Diagnosis and Care, 7) People-centered Systems of Care, and 8) Person-centered Education and Research. On this basis, a Person-centered Care Index was developed composed of 8 broad items and 33 sub-items, each measured on a 4-point scale. The study of its metric structure revealed high Cronbach internal consistency (0.95), scale unidimensionality through factor analysis (69 % of the variance accounted for by the first factor), and interesting inter-correlations such as the sub-item attaining the highest correlation with the global average score being “fulfillment of the person’s life project” (0.88). Validation studies in California, London and Lucknow (India) showed quite high levels of inter-rater reliability (above 0.80 intra-class correlations for most items) and substantial content validity.Discussion: The elucidated core concepts of person centered medicine appear to be consistent with those of international studies on the bases of person- and people-centeredness in primary care and on research and implementation of person centered care. The concepts are also consistent with the key domains of person-centered diagnostic approaches. Further validation studies with larger samples in diverse settings and cultures seem to be warranted.Conclusions. The emerging core concepts of person centered medicine appear to be solid. The Person-centered Care Index built on such concepts appears to have suitable metrics and promising acceptability, reliability and content validity. Further empirical research is recommended.
. Patwardhan B, Warude D, Pushpangadan P, Bhatt N. Ayurveda and traditional Chinese medicine: A comparative overview. Evidence-based Complementary and Alternative Medicine, 2005, 2: 465-473.
. Ierodiakonou CS). Medicine as a model for Aristotle’s ethics and his person-centered approach. International Journal of Person Centered Medicine, 2014, 4: 31-34.
. Jouanna J. Hippocrates. Translated by M.B. Debevoise. Johns Hopkins University Press, Baltimore, 1999.
. Ramose, M.B.. The philosophy of the Ubuntu and Ubuntu as a philosophy. In: The African Philosophy Reader (2nd ed.),ed. P.H. Coetzee & A.P.J. Roux, pp. 230-238. Routledge, NewYork/London, 2003.
. Anzures y Bolaños MC. Medicinas tradicionales y antropología. Anales de Antropología (México), 1978. I.I.A./U.N.A.M. 15: 151.
. Mariátegui J. La concepción del hombre y de la enfermedad en el antiguo Perú. Revista de Neuropsiquiatría, 1992, 55: 156-166.
. Tournier P. Médecine de la Personne. Delachaux et Niestle, Neuchatel, Switzerland, 1940.
. Rogers CR. On becoming a person: a therapist’s view of psychotherapy. Houghton Mifflin. Boston, 1961
. WMA Declaration of Geneva 1948 (2006) (World Medical Association International Code of Medical Ethics. Pilanesberg, South Africa. www.wma.net)
. WMA Declaration of Helsinki (Ethical Principles for Medical Research) http://www.wma.net/en/30publications/10policies/index.html
. McWhinney IR. Family Medicine: A textbook. Oxford University Press, Oxford,1989.
. Garrabe J, Hoff P (2011). Historical views on Psychiatry for the Person. International Journal of Person Centered Medicine 1: 125-127.
. Mezzich JE: Psychiatry for the Person: Articulating Medicine’s Science and Humanism. World Psychiatry, 6: 65-67, 2007
. World Health Organization (2008): World Health Report. Geneva, Author.
. World Health Organization (2009): World Health Assembly Resolutions on Primary Health Care, Including Health System Strengthening, WHA 62.12, 22 May 2009.
. Mezzich JE, Snaedal J, van Weel C, Heath I (2010): Conceptual Explorations on Person-centered Medicine. International Journal of Integrated Care. Vol 10. Supplement
. Mezzich JE, Snaedal J, van Weel C, Botbol M, Salloum I (2011). Introduction to person-centred medicine: from concepts to practice. Journal of Evaluation in Clinical Practice 17(2):330-2.
. Mezzich JE, Snaedal J, van Weel C, Heath I: Toward Person-centered Medicine: From disease to patient to person. Mount Sinai Journal of Medicine 77: 304-306, 2010.
. Mezzich JE, Snaedal J, Van weel C, Botbol M, Salloum I, Van Lerberghe W: Articulating person-centered medicine and people-centered public health: A report from the Fourth Geneva Conference on Person-centered Medicine. World Medical Journal 57: 171-174, 2011.
. Mezzich JE: The Geneva Conferences and the emergence of the International Network of Person-centered Medicine. Journal of Evaluation in Clinical Practice 17: 333-336, 2011.
. Mezzich JE, Snaedal J, van Weel C & Heath I (2009): The International Network for Person-centered Medicine: Background and first steps. World Medical Journal. 55: 104-107.
. Mezzich JE: The construction of person-centered medicine and the launching of an International College. International Journal of Person Centered Medicine 2: 6-10, 2012.
. International College of Person Centered Medicine (2013). Geneva Declaration on Person Centered Health Research. International Journal of Person Centered Medicine, 3:106-107.
. Salvador L, Cloninger CR, Thornicroft A, Mezzich JE et al (2013). Geneva Declaration on Person Centered Health Research. International Journal of Person Centered Medicine 3: 109-113.
. International College of Person Centered Medicine (2014): 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. International Journal of Person Centered Medicine 4: 66-68.
. Cloninger CR, Salvador-Carulla L, Kirmayer L J, Schwartz MA, Appleyard J, Goodwin N, Groves J, Hermans MHM, Mezzich JE, van Staden CW, and Salman Rawaf (2014): A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. International Journal of Person Centered Medicine 4: 69-89.
. Miles A, Mezzich JE (2011): Advancing the global communication of scholarship and research for personalized healthcare: The International Journal of Person Centered Medicine. International Journal of Person Centered Medicine 1: 1-5, 2011.
. Mezzich JE, Appleyard J: Continuing development of person centered medicine and addressing chronic disease. International Journal of Person Centered Medicine 3: 1-4, 2013.
. Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (eds): Person Centered Psychiatry. Springer Verlag, Heidelberg and New York, in press.
. Ortega y Gasset J (1914). Meditaciones del Quijote. Obras Completas de José Ortega y Gasset. Madrid: Editorial Santillana, 2004, Vol 1, pp:745-825.
. Cloninger CR, Salloum IM, Mezzich JE (2012): The dynamic origins of positive health and well being. International Journal of Person Centered Medicine 2: 179-187.
. Mezzich JE: The dialogal bases of our profession: Psychiatry with the Person. World Psychiatry, 6: 129-130, 2007.
. Mezzich JE : Professional perspectives on bridging : The Person-Centered approach. International Journal of Integrated Care. Vol. 9: Supplement on Bridging Knowledge on Long Term Care, 22 June 2009, ISSN 1568-4156, http://www.ijic.org/.
. Kirisci L, Reynolds M, Vanyukov M, Ridenour T, Hayes J, Mezzich JE: Developing an institutional information base and bibliographical clearinghouse. International Journal of Person Centered Medicine 1: 109-112, 2011.
. Kirisci L, Hayes JM, Mezzich JE (in press). Evaluation of person-centered health services. In Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (eds): Person-centered Psychiatry. Springer-Verlag, Heildelberg and New York.
. Krueger RA, Casey MA (2000): Focus Groups: A practical guide for applied research (3rd edition). Thousand Oaks: Sage.
. Linstone HA, Turoff M (1975): The Delphi Method: Techniques and Applications. Reading, Massachusetts: Addison-Wesley Publishing.
. Bunning RL (1979): The Delphi Technique. A projection tool for serious inquiry. The 1979 Annual Handbook for Group Facilitators, University Associates
. Mezzich JE, Good BJ (1997). On Culturally Enhancing the DSM-IV Multiaxial Formulation. In: DSM-IV Sourcebook Washington, DC: American Psychiatric Press 3:983-989.
. Mezzich JE (1999): Ethics and comprehensive diagnosis. Psychopathology. 32: 135-140.
. Kastrup M, Mezzich JE. (2001): Quality of life: a dimension in multiaxial classification. European Archives of Psychiatry and Clinical Neuroscience. 251:Suppl.2, II-32-II/37.
. Mezzich JE, Berganza CE, von Cranach M, Jorge MR, Kastrup MC, Murthy RS, Okasha A, Pull C, Sartorius N, Skodol A, Zaudig M (2003). Essentials of the World Psychiatric Association’s International Guidelines for Diagnostic Assessment (IGDA). British Journal of Psychiatry; 182 (Supplement 45): s37- s66.
. Mezzich JE. (2010): WPA perspectives on person-centered psychiatry and medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Snaedal J. (2010): WMA perspectives on person-centered medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Van Weel C, (2010): Wonca perspectives on person-centered medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Karle H, (2010): WFME perspectives on person-centered medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Vallotton M, (2010): CIOMS perspectives: protecting persons through international ethics guidelines. International Journal of Integrated Care. Vol 10. Supplement.
. Copeland J, (2010): WFMH perspectives on person-centered medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Bartz C, (2010): ICN perspectives on person-centered medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Groves J, (2010): IAPO perspectives on person-centered medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Fulford, B., Bryant, L., & Duhig, L. (2009). Three keys to a shared vision of diagnostic assessment: an initiative in person-centered care from the Department of Health in the UK. International journal of integrated care, 10(Suppl), e013-e013.
. Amering M, (2010): Trialog—an exercise in communication between consumers, carers and professional mental health workers beyond role stereotypes. International Journal of Integrated Care. Vol 10. Supplement.
. Allaz A-F, (2010): Patient-centered curricula at the University of Geneva: opening the door to psychotherapy training. International Journal of Integrated Care. Vol 10. Supplement
. 54. Schaffner KF, (2010): The person and philosophy of science and medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Christodoulou G, (2010): Moral theories and medicine for the person. International Journal of Integrated Care. Vol 10. Supplement.
. Cassell E, (2010): The person in medicine. International Journal of Integrated Care. Vol 10. Supplement.
. Finset A, (2010): Emotions, narratives and empathy in clinical communication. International Journal of Integrated Care. Vol 10. Supplement.
. Pfeifer HR, (2010): Paul Tournier and ‘Médecine de la Personne’—The man and his vision. International Journal of Integrated Care. Vol 10. Supplement.
. Ruedi B, (2010): Scientific developments and medicine of the person. International Journal of Integrated Care. Vol 10. Supplement.
. Sensky T, (2010): Suffering. International Journal of Integrated Care. Vol 10. Supplement.
. Salvador-Carulla L (2010): Defining disability, functioning, autonomy and dependency in person-centered medicine and integrated care. International Journal of Integrated Care. Vol 10. Supplement.
. Cloninger R, (2010). The positive health domain in personcentered integrative diagnosis. International Journal of Integrated Care. Vol 10. Supplement.
. Salloum IM, Mezzich JE (2010): Person-centered Diagnosis. International Journal of Integrated Care. Vol 10. Supplement.
. Van Weel-Baumgarten E (2010): Person-centered clinical practice. International Journal of Integrated Care. Vol 10. Supplement.
. Pare M (2010): Person-centered medicine from deep inside: personal reflections of my depression and recovery. International Journal of Integrated Care. Vol 10. Supplement.
. Wallcraft J, 2010: The service user as a person in health care—service users organising for self empowerment. International Journal of Integrated Care. Vol 10. Supplement.
. Heath I, (2010): Person-centered prevention and health promotion. International Journal of Integrated Care. Vol 10. Supplement.
. Brooker, D, (2004) What is Person Centred Care for people with dementia? Reviews in Clinical Gerontology 13 (3). 215-222.
. Sloane PD, Brooker D, Cohen L, Douglass C, Edelman P, Fulton BR, Jarrott S, Kasayka R, Kuhn D, Preisser JS, Williams CS, Zimmerman S (2007): Dementia care mapping as a research tool. International Journal of Geriatric Psychiatry. 22(6):580-9.
. Brooker D (2007). Person-centred dementia care : making services better. London; Philadelphia : Jessica Kingsley Publishers.
. Organización Panamericana de la Salud (2010). “Redes Integradas de Servicios de Salud: Conceptos, Opciones de Política y Hoja de Ruta para su Implementación en las Américas”. Washington, D.C.: OPS
. Pongsupap Y, Van Lerberghe W, (2006): Choosing between public and private or between hospital and primary care? Responsiveness, patient-centeredness and prescribing patterns in out patient consultations in Bangkok, Tropical Medicine and International Health. 11:81-89.
. World Health Organization (2010) People-centred care in low- and middle-income countries. Third Geneva Conference on Person-centered Medicine. Technical Report, WHO.
. Wallcraft J (1998). Survivor-led research in human services: Challenging the dominant medical paradigm. In: BALDWIN, S. (ed.) Needs Assessment and Community Care: Clinical Practice and Policy Making. Oxford: Butterworth-Heinemann.
. Stewart M et al (2003). Patient-Centered Medicine: Transforming the Clinical Method. 2nd Edition. Radcliffe Medical Press, Oxon UK.
. Adams N, Grieder D (2005): Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery. Elsevier Academic Press, San Diego, CA.
. Van Staden W, (2011). African Approaches to an Enriched Ethics of Person-centred Health Practice. International Journal of Person-centered Medicine. 1: 14-17
. Van Weel-Baumgarten E (2011). Best Evidence Teaching of Communication Skills. International Journal of Person-centered Medicine. 1: 35-38
. Ghebrehiwet T, (2011). Nurse’s Perspectives on Team Approach in Person centered Health Care. International Journal of Person Centered Medicine.1: 20-22
. Bamford T (2011). Social Worker’s Perspectives on Team, Approach in Person-centered Health Care. International Journal of Person Centered Medicine. 1: 23-26
. Jarrott SE, Bruno K (2003). Intergenerational activities involving persons with dementia: an observational assessment. American Journal of Alzheimer's Disease and Other Dementias. 18(1):31-7.
. Martin GW, Younger D (2001). Person-centred care for people with dementia: a quality audit approach. Journal of Psychiatric and Mental Health Nursing. 8(5):443-8.
. Hsu MY, McCormack B (2010). The experience of applying a narrative research approach with older people. The Journal of Nursing Research 18(4):249-57.
. Mezzich JE, Salloum IM, Robert Cloninger C, Salvador-Carulla L, Kirmayer LJ, Banzato CE, & Botbol M (2010). Person-centred Integrative Diagnosis: Conceptual bases and structural model. Canadian Journal of Psychiatry/Revue Canadienne de Psychiatrie, 55(11), 701.
. di Sarsina PR, Iseppato I (2010). Looking for a Person-centered Medicine: Non conventional medicine in the conventional European and Italian setting. Evidence-Based Complementary and Alternative Medicine, 2011.
. Peek CJ (2009). Integrating care for persons, not only diseases. Journal of Clinical Psychology in Medical Settings. 16(1):13-20. Epub 2009 Mar 4.
. Loh KY, Sivalingam N (2008). Enhancing doctor-patient relationship: the humanistic approach. The Medical Journal of Malaysia. 63(1):85-7; quiz 88.
. Rathert C, May DR (2008). Person-centered work environments, psychological safety, and positive affect in healthcare: a theoretical framework. Organ Ethic. Fall-Winter;4(2):109-25.
. Heinssen RK (2007). Person-centered psychiatric care: a tribute to Wayne S. Fenton, MD. Schizophrenia Bulletin. 33(5):1149-50. Epub 2007 Jul 5.
. Henry SG, Zaner RM, Dittus RS (2007). Viewpoint: Moving beyond evidence-based medicine. Academic Medicine. 82(3):292-7.
. Deegan PE, Drake RE (2006). Shared decision making and medication management in the recovery process. Psychiatric Services. 57(11):1636-9.
. Robertson J, Emerson E, Hatton C, Elliott J, McIntosh B, Swift P, Krinjen-Kemp E, Towers C, Romeo R, Knapp M, Sanderson H, Routledge M, Oakes P, Joyce T (2006). Longitudinal analysis of the impact and cost of person-centered planning for people with intellectual disabilities in England. American Journal of Mental Retardation. 111(6):400-16.
. Galland L (2006). Patient-centered care: antecedents, triggers, and mediators. Alternative Therapies in Health and Medicine. 12(4):62-70.
. Ford P, McCormack B (2000). Keeping the person in the centre of nursing. Nursing Standard. 14(46):40-4.
. McBrien B (2009). Translating change: the development of a person-centred triage training programme for emergency nurses. International Emergency Nursing. 17(1):31-7. Epub 2008 Oct 11.
. Slater L (2006). Person-centredness: a concept analysis. Contemporary Nurse. 23(1):135-44.
. Masi AT, White KP, Pilcher JJ (2002). Person-centered approach to care, teaching, and research in fibromyalgia syndrome: justification from biopsychosocial perspectives in populations. Seminars in Arthritis and Rheumatism. 32(2):71-93.
. Lolas F (1985). The psychosomatic approach and the problem of diagnosis. Social Science and Mededicine. 21(12):1355-61.
. Sturmberg JP, Martin CM, Moes MM (2010). Health at the center of health systems reform: how philosophy can inform policy. Perspectives in Biology and Medicine. 53(3):341-56.
. Matomora MK (1989): A people-centered approach to primary health care implementation in Mvumi, Tanzania. Social Science and Medicine. 28(10):1031-7.
. Boise L, White D (2004): The family's role in person-centered care: practice considerations. Journal of Psychosocial Nursing and Mental Health Services. 42(5):12-20.
. Touhy TA (2004). Dementia, personhood, and nursing: learning from a nursing situation. Nursing Science Quarterly. 17(1):43-9.
. Holburn S, Vietze P (1999). Acknowledging barriers in adopting person-centered planning. Mental Retardation. 37(2):117-24.
. Barnard D, Dayringer R, Cassel CK (1995): Toward a person-centered medicine: religious studies in the medical curriculum. Academic Medicine. 70(9):806-13.
. Molton IR, Jensen MP (2010). Aging and disability: biopsychosocial perspectives. Physical Medicine Rehabilitation Clinics of North America. 21(2):253-65.
. Tondora J, O'Connell M, Miller R, Dinzeo T, Bellamy C, Andres-Hyman R, Davidson L (2010). A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos. Clinical Trials. 7(4):368-79. Epub 2010 Jun 22.
. Sommerseth R, Dysvik E (2008). Health professionals' experiences of person-centered collaboration in mental health care. Patient Preference and Adherence. 2:259-69.
. Cronbach, L. Coefficient alpha and internal structure of tests. Psychometrika, 1951; 16:297-334.
. Reckase, M. (1979). Unifactor latent trait models applied to multifactor tests: results and implications. Journal of Educational Statistics, 4(3), 207-230.
. Leyns C , De Maeseneer J (2011). Conceptualizing person- and people-centeredness in primary health care. International Journal Person Centered Medicine 1: 13-22.
. Harris E (2016): Where are we up to, what has been achieved, and what is holding us back? The concepts and results of the Health Foundation’s International Environment Scan on person-centred care. Paper presented at the 9th Geneva Conference on Person Centered Medicine, April 2016, International College of Person Centered Medicine.
. Stewart M, Brown JB, Donner A, McWhinney DR, Oates J, Weston W, Jordan J (2000). The impact of patient-centered care on outcomes. Journal of Family Practice 49: 796-804.
. Stewart M (2001): Towards a global definition of patient centred care. British Medical Journal 322: 444-445.
. 114. Epperly T (2011). The Patient‐Centred Medical Home in the USA. Journal of Evaluation in Clinical Practice, 17(2), 373-375.
. Asociación Psiquiátrica de América Latina (APAL) (2013). Guía Latinoamericana de Diagnóstico Psiquiátrico, versión revisada (GLADP-VR). Sección de Diagnóstico y Clasificación, APAL, Lima.