Barriers and facilitators to the implementation of person‐centred care in different healthcare contexts

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Patient‐centred care is professed to have more evangelists than practitioners 1, yet models of person‐centredness and patient‐centredness have become increasingly adopted by policy‐makers 2. Recent debates about patient‐centredness and person‐centredness demonstrate a shift towards inclusivity and equity in the professional–patient relationship 4. In keeping with other healthcare providers internationally, Swedish healthcare professionals seek to strengthen the position of patients and their participation in care 5.
Although patient‐centred care and person‐centred care (PCC) are frequently conflated in the literature, in both, professionals are encouraged to acknowledge the patient as an equal partner in the development and assessment of their care 6. Evidence suggests that PCC can be delivered effectively 8, and patients with long‐term conditions benefit from this approach 9. Moreover, researchers report that PCC can be facilitated through effective leadership 12 and by knowledgeable professionals with sound communication skills 7.
The uptake of PCC remains sporadic as barriers are identified as well as facilitators 14. As McCormack 19 suggests the context of the care environment has the greatest potential to restrict or support PCC in practice. The implementation of PCC can also vary depending upon patient populations, providers of care and settings and how professionals and patients understand what constitutes caring 20. Additional challenges to PCC include professional practice, beliefs and cultures 21; professionals erroneously believing that they are practicing PCC; or reverting to disease‐centred care when under pressure 15. How PCC is translated into practice remains challenging 22 and person‐centredness needs to be considered in the wider context in terms of the care environment and beyond 17.
The implementation of PCC poses challenges. Few studies describe how healthcare professionals can become proficient, well‐trained PCC practitioners and integrate theory into practice in contrasting settings 23. Less is known about what we can learn from implementing and evaluating PCC in the context of routine care, patients’ priorities and personal needs. Addressing these gaps is important to gain insight into the factors that help or hinder understanding, acceptance and implementation.
To improve the practice of PCC, researchers at the University of Gothenburg, Sweden, successfully obtained national funding to establish the Centre for Person‐Centred Care (GPCC). At GPCC, about 40 research projects are currently investigating PCC from the perspective of people with long‐term conditions and health professionals delivering care 24. These studies are based in various hospital, primary care and community settings in Sweden. At GPCC, the term person‐centred care (PCC), as opposed to patient‐centred care is preferred, as this acknowledges the person behind the patient 12. This centre funds and conducts research in the field of PCC, in a variety of healthcare settings, anchored within a model of PCC that has clear philosophical and practical guidance. The GPCC model of PCC relies upon three simple routines 15. The first routine elicits the patient narrative or subjective account of the person's illness experience, strengths and future plans. The second agrees a partnership with shared decisions and goals between professional, patient and often their relatives, and the third routine ensures this partnership and narrative is documented. 12. These routines were initially tested in a controlled clinical study of people hospitalised for worsening chronic heart failure and further developed in a recent randomised clinical study on acute coronary syndrome (ACS) 26, referred to here as the index project. This subsequently formed the basis for the GPCC model.
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