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Improving patient-centered care for people with dementia in medical encounters: an educational intervention for old age psychiatrists

Published online by Cambridge University Press:  17 July 2009

Louise Robinson ,
Claire Bamford ,
Ruth Briel ,
John Spencer  and
Paula Whitty
Louise Robinson*
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K.
Claire Bamford
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K.
Ruth Briel
Affiliation:
Tees, Esk & Wear Valley NHS Trust, Bowes Lyon Unit, Earls House Hospital, Durham, U.K.
John Spencer
Affiliation:
School of Medical Education, Newcastle University, Newcastle upon Tyne, U.K.
Paula Whitty
Affiliation:
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K.
*
Correspondence should be addressed to: Dr. Louise Robinson, Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, U.K. Phone: +44 (0)191 222 7013; Fax: +44 (0)191 222 6043. Email: a.l.robinson@ncl.ac.uk.
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Abstract

Background: Health care professionals are recommended to deliver patient-centered care in dementia; however, guidance and training on how to do this in practice is currently lacking. The aim of this study was to develop and evaluate pragmatically an educational intervention for old age psychiatrists to promote patient-centered care in their consultations with people with dementia and their carers.

Methods: We used a range of methods to (i) identify the theoretical components of patient-centered care (literature review) and (ii) observe actual practice (video recording of 53 consultations between old age psychiatrists and people with dementia and their family carers). We also interviewed participants from (ii) including 7 old age psychiatrists, 25 people with dementia and 44 carers. From this we developed a workshop for old age psychiatrists and piloted and evaluated it. Pre- and post-workshop questionnaires were completed; the latter included an assessment of planned and subsequent behavior change by participants.

Results: The educational workshop, attended by 41 old age psychiatrists, focused on how best to structure the consultation and the most effective communication skills to use in consultation with people with dementia. Three months after the workshop, 59% had made one or more changes to the structure of their consultations, 71% had used new communication skills and 56% had reflected further on their practice.

Conclusions: We developed an educational intervention with both a theoretical and empirical basis. The workshops resulted in many changes to self-reported practice; whether this was noticeable to patients and carers requires further study.

Keywords

dementiaolder peopleperson centeredpatient centerededucationintervention
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 129 - 138
Copyright
Copyright © International Psychogeriatric Association 2009

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References

American Academy of Pediatrics Committee of Hospital Care (2003). Family-centered care and the pediatrician's role. Pediatrics, 112, 691–696.CrossRefGoogle Scholar
Bamford, C., Hughes, J. and Robinson, L. (2007). Improving patient-centred care for people with dementia in medical encounters. Gerontologist, 47, 158–159.Google Scholar
Beisecker, A. E., Chrisman, S. K. and Wright, L. J. (1997). Perceptions of family caregivers of persons with Alzheimer's disease: communication with physicians. American Journal of Alzheimer's Disease, March/April, 73–83.CrossRefGoogle Scholar
Brooker, D. (2004). What is person-centred care in dementia?, Reviews in Clinical Gerontology, 13, 215–222.CrossRefGoogle Scholar
Cherry, D. L., Hahn, C. and Vickery, B. G. (2009). Educating primary care physicians in the management of Alzheimer's Disease: using practice guidelines to set quality benchmarks. International Psychogeriatrics, 21 (Suppl. 1), S44–S52.CrossRefGoogle ScholarPubMed
Department of Health (2001). National Service Framework for Older People. London: NHS Executive.Google Scholar
Department of Health (2006). Good Doctors, Safer Patients. London: Department of Health.Google Scholar
Department of Health (2008). Medical Revalidation: Principles and Next Steps. The Report of the Chief Medical Officer for England's Working Group. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086430 (last accessed 12 December 2008).Google Scholar
Department of Health (2009). Living Well with Dementia: A National Strategy. Available at: http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Olderpeople/NationalDementiaStrategy/index.htm (last accessed: 23 March 2009).Google Scholar
Dillman, D. (1991). The design and administration of mail surveys. Annual Review of Sociology, 17, 225–229CrossRefGoogle Scholar
Doyle, C. (2009). International perspectives on dementia education, training and knowledge transfer. International Psychogeriatrics, 21 (Suppl. 1), S1–S2.CrossRefGoogle ScholarPubMed
Foy, R. et al. (2007). The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia. BMC Health Service Research, 7, 207. doi: 10.1186/1472–6963/7/207.CrossRefGoogle ScholarPubMed
General Medical Council (2003a). Tomorrow's Doctors. London: General Medical Council.Google Scholar
General Medical Council (2003b). A Licence to Practise and Revalidation. London: General Medical Council.Google Scholar
Greene, M. G., Majerovitz, S. D., Adelman, R. D. and Rizzo, C. (1994). The effects of the presence of a third person on the physician-older patient medical interview. Journal of the American Geriatrics Society, 42, 413–419.CrossRefGoogle ScholarPubMed
Hasselkus, B. R. (1992). Physician and family caregiver in the medical setting: negotiation of care? Journal of Aging Studies, 6, 67–80.CrossRefGoogle Scholar
Hirschman, K. B., Xie, S. X., Feudtner, C. and Karlawish, H. T. (2004). How does an Alzheimer's disease patient's role in medical decision-making change over time? Journal of Geriatric Psychiatry and Neurology, 17, 55–60.CrossRefGoogle ScholarPubMed
House of Commons Committee of Public Accounts (2008). Improving Services and Support for People with Dementia. Sixth Report of Session 2007–08 (HC 228). London: The Stationery Office.Google Scholar
Hughes, J., Bamford, C. and May, C. (2008). Types of centredness in health care: themes and concepts, Medicine Health Care and Philosophy. doi: 10.1007/s11019-008-9131-5.CrossRefGoogle Scholar
Mackinnon Partnership (2007). A Literature Review of the Relationship between Quality Health Care Education and Quality of Care. Perivale, Middlesex: The Mackinnon Partnership.Google Scholar
May, C. and Mead, N. (1999). Patient-centredness: a history. In Dowrick, C. and Frith, L. (eds.), Ethical Issues in General Practice: Uncertainty and Responsibility (pp. 76–91). London: Routledge.Google Scholar
McColl, E. et al. (2001). Designing and using patient and staff questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technology Assessment, 5, 31.CrossRefGoogle ScholarPubMed
Mead, N. and Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science and Medicine, 51, 1087–1110.CrossRefGoogle ScholarPubMed
National Audit Office (2007). Improving Services and Support for People with Dementia. London: The Stationery Office.Google Scholar
NICE/SCIE (2006). Dementia: Supporting People with Dementia and their Carers in Health and Social Care. London: National Institute for Clinical Excellence and Social Care Institute for Excellence.Google Scholar
Noble, L. M., Kubacki, A., Martin, J. and Lloyd, M. (2007). The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education, 41, 432–440.CrossRefGoogle ScholarPubMed
Nolan, M. R., Davies, S., Brown, J., Keady, J. and Nolan, J. (2004). Beyond “person-centred” care: a new vision for gerontological nursing. Journal of Clinical Nursing, 13, 45–53.CrossRefGoogle Scholar
O'Brien, M. A., Freemantle, N., Oxman, A. D., Wolf, F., Davis, D. A. and Herrin, J. (2001). Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, Art. No.:CD003030.Google Scholar
Rogers, C. R. (1951). Client-centred Therapy. Boston: Houghton Mifflin.Google Scholar