In this week’s Evidence Based Nursing Blog, Andrew Cassidy (@mrandycassidy) brings his own personal lived experiences and professional thoughts from his years working in the NHS and other sectors on what being person-centred looks like.
I’ve worked in the healthcare for nearly fifteen years, in the NHS, the third sector, and for a social enterprise. In spite of the differences in these roles, a main focus of each of them has been on the provision of person-centred care. But what is person-centred care, and how can one person be expected to say what is and what isn’t person centred for someone else?
This question was brought into sharp relief in the early days of the pandemic. I have Crohn’s Disease, and take immunosuppressant medication to keep it under control. This placed me in the shielding group, and led to one of the most challenging conversations that I have ever had with my healthcare team.
Early in the morning of March 23rd, my GP called to ask me how I would feel about having a DNR placed on my medical records. I have a good relationship with my GP, and her manner was sensitive and, I felt, pitched at a level I would respond to. We’ve always been candid in our conversations, and I appreciated this candour in our conversation, but it made me think. My conversation with my GP was structured around my level of understanding and my “expertise” of my own condition. However, I appreciate how difficult that conversation would have been for my GP to instigate, and I began to wonder how the conversations she had with other patients in my position were positioned. Were they all as “person-centred” as the conversation I had?
This made me think about my professional life, and the roles of my clinical colleagues. As nurses, they are expected to provide person-centred care in all circumstances. But how can “person-centred-ness” be quantified? Two people could look at the same interaction, and arrive at two polar opinions as to whether or not it was person-centred. Is there a universal definition, or is it nebulous and does that definition differ from person to person? Further, if there is no definitive definition – and, if the notion of what is and is not “person-centred” varies from person to person, then surely there cannot be? – how can we reasonably expect professionals themselves to determine whether their interactions are person-centred or not?
I decided to examine my own experiences of care, and to try to determine what factors were important in my appraisal of whether or not they were person-centred. My first thoughts ran to health literacy. For me, the first step of a person-centred approach is communicating at a level people are comfortable with. I’ve had Crohn’s for over twenty years, and conversations about antiemetics, 5-ASA’s, and terminal ilea do not faze me, but I can imagine the confusion these conversations would give rise to someone who has been newly diagnosed. But here’s the rub; that’s precisely what makes it person-centred for me. The very aspect that makes it person-centred to me could have completely the opposite effect on someone else.
This leaves a very obvious question; can we truly expect professionals to know at first glance or interaction the approach that would suit every patient and pitch their interactions accordingly? And, if so, how can policies be made at Trust / Health Board / National levels when we have a virtual smorgasbord of opinions on what person-centred is and isn’t.
For me, the essence of person-centred care comes down to ascertaining what is important to the person themselves. Recent initiatives have led the way on this, notably the Scottish Government’s What Matters to You, have shone a light on a way forward. A system simply cannot decide what being person-centred looks like, but getting to the heart of what is important to the person can provide a starting point. What matters to the person should influence everything in a healthcare environment, from communications to potential treatment options and long-term support and care. Only once what matters to someone is identified and valued can systems begin to design a package of care that truly puts people at the centre.