Development and testing af an observation-based method to assess person-centeredness in healthcare

Abstract

Person-centred care (PCC) has been designated and endorsed as a core competency needed for health care professionals (HCP) to meet the evolving challenges facing health care. The aim of this thesis was to develop and test an observation-based method for assessing clinician competency in the delivery of PCC.

Study I reviewed existing PCC direct observation tools (DOT). Few of the identified 16 tools specified their conceptual base, assessed PCC holistically, were rigorously tested for reliability and validity, and none involved patients in their development.

Study II aimed to identify observable indictors of PCC through interviews with 12 patients, relatives and HCPs with experience of PCC for potential inclusion in a new DOT. Deductive content analysis was performed based on the Gothenburg Centre for Person-centred Care (GPCC) PCC framework (gPCC). Patients´ first impressions were considered to impact the content, course and outcomes of the interaction and nonverbal behaviours were seen to play a major role in shaping patients’ impressions of HCPs. Study III explored the content and usability of a preliminary DOT assessing PCC competency in four main areas, subdivided in 13 domains and each illustrated by one or more behavioral indicators. Content and usability of the tool were explored using think aloud and probing techniques in 11 patients and HCPs. In general, the participants judged the tool to be easy to use and to satisfactorily cover major PCC activities outlined in the gPCC.

Study IV evaluated the inter-rater reliability of a revised version of the DOT. Six HCPs with no training in using the DOT each rated 10 video recorded patient-HCP interactions. Intraclass correlations were fair to excellent range for 13 of the 15 domains.

In conclusion, the tool appears promising for formative use in guiding and structuring observation-based assessments and providing feedback to trainees; however, further evaluations are required to support high-stakes usage.