Document Detail


Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.
MedLine Citation:
PMID:  17196906     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs. The study was guided by a conceptual framework grounded in existing models to address five dimensions of doctor-patient relationships: range of needs addressed, source of authority, maintenance of trust, emotional involvement, and expression of authenticity. Data collection included observation of the care of 40 patients in the inpatient hospice unit and at home, interviews with patients and family members, and in-depth interviews with 22 physicians and two nurses providing end-of-life care. Standard qualitative procedures were used to analyze the data, incorporating techniques for maximizing the validity of the results and broadening their relevance to other contexts. Findings provide evidence for challenging prominent assumptions about possibilities for doctor-patient relationships: questioning the merits of the prohibition on emotional involvement, dependence on protocols for handling difficult communication issues, unqualified reliance on consumer empowerment to assure that care is responsive to patients' needs, and adoption of narrowly defined boundaries between medical and social service systems in caring for patients. Medical education can play a role in preparing doctors to assume new roles by openly addressing management of emotions in routine clinical work, incorporating personal awareness training, facilitating reflection on interactions with patients through use of standardized patients and videotapes, and expanding capacity to effectively address a broad range of needs through teamwork training.
Authors:
Michael J Yedidia
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of pain and symptom management     Volume:  33     ISSN:  0885-3924     ISO Abbreviation:  J Pain Symptom Manage     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-01     Completed Date:  2007-03-20     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  8605836     Medline TA:  J Pain Symptom Manage     Country:  United States    
Other Details:
Languages:  eng     Pagination:  40-57     Citation Subset:  IM    
Affiliation:
Rutgers Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA. myedidia@ifh.rutgers.edu
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MeSH Terms
Descriptor/Qualifier:
Humans
Palliative Care / organization & administration*
Patient-Centered Care*
Physician's Role
Physician-Patient Relations*
Grant Support
ID/Acronym/Agency:
1R01 HS013543/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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