Special Interest Group 7: AR and Its Instrumentation

Transcription

1 Special Interest Group 7: AR and Its Instrumentation

2 Sue Ann Erdman ARCCS, Jensen Beach FL Lesley Jones Hull York Medical School UK Joseph J. Montano Weill Cornell Medical College, NY, NY David J. Wark University of Memphis, Memphis, TN

3 Relevant financial relationships: None Relevant non-financial relationships: Volunteer consultant for the Ida Institute

4 Patient/Person/Relationship Centered Care

5 What will you learn today? What is patient/person/relationship-centered care? How did this approach to healthcare develop? What are the essential components of PCC/RCC? Narratives/Empathy/Mutual understanding/shared decision making Why is PCC/RCC important? How can we prepare students to provide PCC/RCC? How do we implement PCC/RCC in audiologic practice? As established clinicians, how do we shift our perspective?

6 Hippocrates: The Father of Medicine It is more important to know what person the disease has than to know what disease a person has. (individual differences) Cure sometimes, treat often, comfort always. (empathy) Hippocrates (ca BC)

7 The traditional medical model is based on dualism and reductionism The medical model entails assuming a detached perspective: just find the broken part and fix it The underlying belief has been that if there is a problem the medical model has not yet solved, it will certainly be able to do so in the future Often necessary and appropriate for acute care Inadequate for chronic conditions

8 The Biopsychosocial Model Engel insisted the medical model is flawed because it does not consider the whole person and it cannot account for individual differences in perceived illness. nothing will change unless or until those who control resources have the wisdom to venture off the beaten path of exclusive reliance on biomedicine as the only approach to health care. George L. Engel ( ) The Need for a New Medical Model: A Challenge for Biomedicine (1977) has been cited 6750 times Slide 8

9 The Biopsychosocial Model The patient is viewed as a whole person The patient s story, or narrative, is focal The practitioner fosters an empathic, trusting relationship by understanding and by being understanding Shared communication, decisions, and responsibilities Patients are engaged in treatment plans and process Systems theory rather than dualism and reductionism (Engel, 1977, 1980, 1988)

10 Medical Model vs. Biopsychosocial Model Top-down communication Authoritarian Clinician diagnoses Clinician does something to clients Disease/impairment focused Clinician knows what s best and sets treatment goals May be necessary in acute, emergency situations Curative Horizontal communication Interactive, facilitative Patient identifies problems Clinician does something with clients Person focused Patient s perceptions and needs determine goals, strategies For chronic conditions requiring self-management/adherence Empowering, self-actualizing (Erdman, Wark, & Montano, 1994) Slide 10

11 Defining Patient-Centered Care Patient-centered care: is respectful of and responsive to individual patients preferences, needs, and values; ensures that patient values guide clinical decisions; encompasses qualities of empathy and compassion. Crossing the Quality Chasm: A New Health System for the 21 st Century (National Academy of Sciences Institute of Medicine, 2001)

12 Approaches to Patient-Centered Care Calgary-Cambridge Observation Guides (Kurtz & Silverman, 1996) Four Habits Model (Frankel & Stein, 1999) Patient-Centered Clinical Method (Stewart, Brown, Weston, McWhinney, McWilliam, & Freeman, 2003) Smith s Evidence-Based Interviewing Method (Smith, 1996, 2002) Slide 12

13 Patients want care that: Includes an understanding of their world, i.e., their whole person, emotional needs, and life issues Finds common ground on what the problem is and achieves mutually agreed upon management Enhances the continuing practitioner/patient relationship and discourages doctor shopping Enhances prevention and health promotion (Stewart, 2001)

14 Patients want care that Explores their concerns and reasons for consultation

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16 Patients want care that Explores their concerns and reasons for consultation Includes an understanding of their world, i.e., their whole person, emotional needs, and life issues

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18 Patients want care that: Explores their concerns and reasons for consultation Includes an understanding of their world, i.e., their whole person, emotional needs, and life issues Finds common ground on what the problem is and achieves mutually agreed upon management

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21 Client/Person Centered Therapy Warmth, empathy, trust, respect, genuineness, and unconditional positive regard: Define the therapeutic relationship Are more salient than any other variables in the treatment process Are personal attributes that the effective counselor presents to the client Carl Rogers ( ) Empathy early in the relationship predicts later success.

22 Rogers influence When someone really hears you without passing judgment on you, without taking responsibility for you, without trying to mold you it feels damn good! His concepts of ideal self vs. real self are central to understanding why people react differently to disability Man s inability to communicate is a result of his failure to listen effectively.

23 The therapeutic relationship is among the most salient variables in health care. This relationship is a medium for the exchange of all forms of information, feelings, and concerns, a factor in the success of therapeutic regimens, and an essential ingredient in the satisfaction of both patient and practitioner. For patients, the relationship with their provider is frequently the most therapeutic aspect of the health care encounter. (Tresolini and the Pew Fetzer Task Force,1994)

24 Practitioner-Patient/Clinician-Client Relationship: The Working Alliance consists of an emotional bond, agreement on tasks, and agreement on goals The relationship between clinician-client has a major influence on treatment outcome. Relationship-centered care has positive outcomes on both parties. Evidence that training can improve alliance.

25 Principles of Relationship-Centered Care Relationships in health care should include the personhood of all participants. Affect and emotion are important components of these relationships. All health care relationships occur in the context of reciprocal influence. Forming and maintaining genuine relationships in health care is morally valuable. (Beach, Inui, & Relationship-Centered Care Research Network, 2005) Slide 25

26 Relationship-Centered Care Minimizes the concerns associated with the patient-centered and biomedical model. A continuous healing relationship is the most critical ingredient in improving the quality of patient care (IOM, 2001). Relationship-centered care is an expansion of patient-centered care, and a direct outgrowth of the biopsychosocial model. Patient-centered care is enhanced by relationship-centered care: the quality of the relationship determines treatment success.

27 Relationship-Centered Care Improves Three Critical Relationships The relationship between caregivers and the patients and families they serve. The relationship among members of the health care team. The caregiver s relationship with self Slide 27

28 Benefits of PCC/RCC Greater patient satisfaction Fewer prescriptions, referrals, diagnostic tests Cost containment Enhanced treatment adherence Better treatment outcomes Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. R. (2003). Patient-Centered Medicine: Transforming the Clinical Method Method (2nd ed.). Abingdon, UK: Radcliffe Medical Press.

29 Clinical Implications of Person-Centered Care Addresses the individual s specific and holistic characteristics Addresses the person s difficulties in everyday life (i.e., participation limitations and restrictions) Views the person as an expert on his or her own condition and puts emphasis on participation and empowerment Respects the person with the impairment, disability, or disease Provides empathy because by understanding and valuing the individual, we increase our understanding and valuing of individual differences and diversity

30 PCC and RCC Commonalities Whole person/biopsychosocial Patient narrative Therapeutic context and environment Empathy Validation Therapeutic relationship Mutual understanding Shared decision making Self-efficacy/Self-management Promotion of adherence Increased patient satisfaction Improved treatment outcomes

31 Therapeutic Levels in AR (Erdman, 2013)

32 Implications for AR Although there are predictable normative patterns to adjustment to hearing impairment, individual patterns of adjustment are unpredictable. Individuals adjustment patterns should be assessed to determine the nature and extent of variables affecting communication and psychosocial adjustment. Rehabilitation programs should address the normative needs of clinical populations and be flexible enough to meet the needs of individuals. Clinicians must be prepared to address the psychosocial and behavioral variables associated with adjustment to hearing impairment. Erdman & Demorest (1998a,b)

33 There is enough evidence of professional noncompliance for it to seem likely that even if clinicians are aware of the techniques necessary to ensure that patients adhere to treatment recommendations, they would not necessarily use them. (Ley, 1986) Slide 33

34 Shifting Our Perspective The most frequently recommended ways to adopt a more PCC/RCC approach in healthcare include reflection and mindful practice.

35 Mindful practice facilitates adoption of PCC/RCC Being mindful consists of clearing one s mind, being fullypresent in the moment, and adapting a stance of open, nonjudgmental curiosity. Mindful decisions and interactions enable us to instill trust, and cultivate active, engaged patients. A mindful communication program for physicians improved their self-awareness and their ability to be attentive, to listen deeply to their patients, to respond to patients more effectively, and to develop adaptive reserve (Beckman et al., 2012) Slide 35

36 Mindful practice involves reflecting on ourselves, our practice, and our world Slide 36

37 Slide 37

38 Mindfulness: Aware, present, nonjudgmental Slide 38

39 Mindfulness is the opposite of multitasking!

40 The only person who is educated is one who has learned how to learn and change. Carl Rogers