Skip to main content
×
Home

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

  • Louise Robinson (a1), Claire Bamford (a1), Ruth Briel (a2), John Spencer (a3) and Paula Whitty (a1)...
Abstract
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.

Copyright
Corresponding author
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.
References
Hide All
American Academy of Pediatrics Committee of Hospital Care (2003). Family-centered care and the pediatrician's role. Pediatrics, 112, 691696.
Bamford C., Hughes J. and Robinson L. (2007). Improving patient-centred care for people with dementia in medical encounters. Gerontologist, 47, 158159.
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.
Brooker D. (2004). What is person-centred care in dementia?, Reviews in Clinical Gerontology, 13, 215222.
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), S44S52.
Department of Health (2001). National Service Framework for Older People. London: NHS Executive.
Department of Health (2006). Good Doctors, Safer Patients. London: Department of Health.
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).
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).
Dillman D. (1991). The design and administration of mail surveys. Annual Review of Sociology, 17, 225229
Doyle C. (2009). International perspectives on dementia education, training and knowledge transfer. International Psychogeriatrics, 21 (Suppl. 1), S1S2.
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.
General Medical Council (2003a). Tomorrow's Doctors. London: General Medical Council.
General Medical Council (2003b). A Licence to Practise and Revalidation. London: General Medical Council.
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, 413419.
Hasselkus B. R. (1992). Physician and family caregiver in the medical setting: negotiation of care? Journal of Aging Studies, 6, 6780.
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, 5560.
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.
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.
Mackinnon Partnership (2007). A Literature Review of the Relationship between Quality Health Care Education and Quality of Care. Perivale, Middlesex: The Mackinnon Partnership.
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. 7691). London: Routledge.
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.
Mead N. and Bower P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science and Medicine, 51, 10871110.
National Audit Office (2007). Improving Services and Support for People with Dementia. London: The Stationery Office.
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.
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, 432440.
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, 4553.
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.
Rogers C. R. (1951). Client-centred Therapy. Boston: Houghton Mifflin.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 6
Total number of PDF views: 45 *
Loading metrics...

Abstract views

Total abstract views: 235 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.