APA PFCC SIG Blog Post
PFCC SIG Co-Chairs: Jody L. Lin, MD, MS, Rebecca Rosenberg, MD, MPH, Arti Desai, MD, MSPH
Patient- and family-centered care in 2020. Below we discuss what we should strive for in clinical care and research related to patient- and family-centered care and how we may continue striving for these ideals in the midst of a pandemic. A few articles published in the past year describe what patient- and family-centered care should ideally look like:
Presence and connection in clinical care: Using a systematic review and Delphi process, Zulman, et al1 identify five recommendations to foster physician presence and connections with patients: (1) prepare with intention by taking a moment to focus before greeting a patient; (2) listen intently and completely by sitting down, leaning forward, and avoiding interruptions; (3) agree on what matters most by incorporating patient priorities into the visit agenda; (4) connect with the patient’s story by considering life circumstances that influence the patient’s health; and (5) explore emotional cues.
Engaging key stakeholders in research: Harrison, et al2 used stakeholder engagement methods to create a patient- and family-centered research agenda for hospital medicine. Key areas for focus included: shared decision making for treatments and goals of care, hospital discharge handoff, and patient and caregiver education on medications, conditions, hospital care, and discharge.
While these are logical foci for further hospital medicine research, some innovations around hospital-to-home transitions are already being done in industry and studied in pediatric hospital medicine for medically complex children, as PFCC co-chair Dr. Rebecca Rosenberg notes in the Commentary3.
Keeping child health equity front and center: Berwick4 reminds us that we must always look upstream to help our patients and families in the larger ecosystem of care, particularly by addressing social determinants of health and racism beyond the traditional health care system. Boyd et al.5 outlines standards for how we discuss patients and families in our research to address racial health inequities.
Advancing patient- and family-centered care. However, the COVID-19 pandemic poses significant challenges to the quality of patient- and family-centered care. The perceived coldness of full-body PPE has been mitigated in part by personal photos donned over PPE. To overcome additional barriers to patient- and family-centered care, we highlight a few innovations and resources below:
Telehealth relation-based communication: With telehealth thrust upon many of us, one of the struggles we face in maintaining a connection with our patients and families. Cooley6 adapts the principles of relation-based communication to telehealth including: optimizing the “space” for connections through audio and video quality, listen attentively by minimizing distractions, and responding empathically by summarizing, naming the emotion, and offering a supportive statement. Additional tips can be found here: https://www.achonline.org/COVID-19/Telemedicine.
Preserving family-centered communication in the hospital: Restrictions on family visitation in most hospitals heightened a sense of isolation and anxiety for the parent who stays at the bedside and the family who cannot join. Hart et al7 provides suggestions for synchronous and asynchronous communication with families of different technological resources including: employing night and weekend coverage providers to communicate with families, providing hospital devices for family videoconference, and accessing translation services during video- and tele-conferencing.
Finally, the PFCC SIG together with the Latino Child Health SIG planned a PAS session around engaging patients and families in research, which we hope to relaunch for PAS 2021.
- Zulman DM, Haverfield MC, Shaw JG, et al. Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter [published correction appears in JAMA. 2020 Mar 17;323(11):1098]. JAMA. 2020;323(1):70-81. doi:10.1001/jama.2019.19003
- Harrison, James, Archuleta, Michelle, Avitia, Esther, et al. Developing a Patient- and Family-Centered Research Agenda for Hospital Medicine: The Improving Hospital Outcomes through Patient Engagement (i-HOPE) Study. Journal Of Hospital Medicine. 2020;15(6):331-337. doi:10.12788/jhm.3386.
- Glick AF, Jacobs-Shaw RE, Rosenberg RE. Setting an Agenda for Hospital Medicine Research: Making Sure the Right People Are at the Table. J Hosp Med. 2020;15(6):383-384. doi:10.12788/jhm.3403
- Berwick DM. The Moral Determinants of Health. 2020;324(3):225–226. doi:10.1001/jama.2020.11129
- Boyd RW, Lindo EG, Weeks LD, McLemore MR. “On Racism: A New Standard For Publishing On Racial Health Inequities, ” Health Affairs Blog, July 2, 2020. DOI: 10.1377/hblog20200630.939347
- Cooley L. Fostering human connection in the COVID-19 virtual health care realm. NEJM Catalyst. 2020. Doi: 1056/CAT.20.0166
- Hart JL, Turnbull AE, Oppenheim IM, Courtright KR. Family-Centered Care During the COVID-19 Era. J Pain Symptom Manage. 2020;60(2):e93-e97. doi:10.1016/j.jpainsymman.2020.04.017