Conceptual Framework for Practicing Person-Centred Care
The American Heart Association's 2023 scientific statement provides the most comprehensive and current conceptual framework, defining person-centered care through three essential components: (1) focused assessment of the patient narrative, (2) a plan of care codesigned by the patient and clinician, and (3) iterative reassessment or adjustment of the patient's goals for care over time. 1
Core Definitional Elements
Person-centered care fundamentally requires care that is "respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions." 1 This framework extends beyond simple treatment choices to encompass:
- Patient empowerment and individuality as foundational principles 2
- A biopsychosocial approach that considers both internal capacity (physical ability, skills, knowledge) and external capacity (financial resources, community support, lifestyle, culture) 1
- Respect for the patient as a person that goes beyond merely respecting their treatment choices 3
The Three-Pillar Implementation Framework
1. Assessment of Patient Narrative
Begin by understanding what matters to the individual patient through direct inquiry and active listening. 1 This requires:
- Complete information provision including existence of alternatives and their merits and shortcomings 1
- Assessment of health literacy as the foundation for self-management programs and productive clinician-patient interactions 1
- Exploration of the patient's social network, quality of life priorities, and self-identity 4
- Understanding physical, psychological, social, and existential needs of both patient and family 4
2. Codesigned Care Planning
The clinician must engage in genuine partnership where both parties contribute expertise—the clinician provides medical knowledge while the patient contributes lived experience and values. 3 This involves:
- Shared decision-making (SDM) as a core tenet, requiring patient knowledge and self-monitoring capabilities 1
- Collaboration in all aspects of clinical care, not just isolated treatment decisions 3
- Direct and particular knowledge of the patient sufficient for the clinician to answer "What would you do if you were me?" 3
- Integration of patient-reported outcome measures (symptoms, function, quality of life) into routine clinical practice 1
3. Iterative Reassessment Over Time
Person-centered care requires ongoing adjustment as patient circumstances, preferences, and goals evolve. 1 This necessitates:
- Continued physician-to-patient communication as intrinsic to managing chronic conditions 1
- Frequent monitoring and patient communication correlating with achievement of treatment goals 1
- Flexibility to adapt skills, communication, routines, or environments for individual patients 4
- Promotion of continuation of normality and self-identity throughout the care trajectory 4
System-Level Requirements
Effective person-centered care cannot exist solely at the individual clinician-patient level but requires organizational transformation. 5 The framework must address:
Organizational Structure
- Evidence-based practices with clinical decision support tools 1
- Infrastructure improvements including information technology to enhance partnerships between patients and healthcare teams 1
- Quality improvement processes with ongoing evaluation 1
- Service organization structured to enable care continuity 4
Healthcare Professional Development
- Focused education on person-centered care competencies for clinicians 1
- Training in communication skills and patient engagement strategies 2
- Clinician empowerment as a priority area for enabling routine PCC integration 2
Multidisciplinary Engagement
- Balanced representation of generalists, specialists, allied professions, nurses, pharmacists, and individuals with lived experience 1
- Collaborative efforts to prioritize health needs among clinicians, patients, and communities 1
- Involvement of families and communities in healthcare delivery 5
Critical Implementation Considerations
Common Pitfalls to Avoid
The "What Matters to You?" approach, while directionally correct, can lead to oversimplified understanding of individual preferences if not properly contextualized. 6 Avoid:
- Focusing solely on treatment choices while neglecting broader life circumstances 3
- Assuming patient preferences are static rather than evolving 1
- Overlooking social determinants of health and structural barriers to care 1
- Using person-centeredness as a research metric only rather than integrating it into clinical practice 1
Addressing Complexity
Person-centered care for chronic conditions requires acknowledging that patients rarely present with single, isolated conditions. 1 The framework must:
- Address multimorbidity rather than single-disease guidelines 1
- Consider how capabilities and resources affect patient responding to care recommendations 6
- Engage with the degree of complexity within healthcare systems that militates against satisfactory implementation 5
- Support clinicians in addressing complex patient care needs over time with adequate resources 1
Evidence Gaps and Future Directions
Current evidence supporting optimal person-centered care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet needs of patients with chronic, complex conditions. 1 Key limitations include:
- Lack of systematic approaches to engage patients and incorporate their perspectives into treatment plans 1
- Inconsistent use of established definitions and outcome measures across studies 1
- Need for culture change at the systems-level to enable routine integration 2
- Requirement for properly aligned financial incentives for managing chronic diseases 1
The framework emphasizes that improving care delivery requires stronger evidence on person-centered outcomes linking cost with patient outcomes to gain support of policymakers who can ensure appropriate resources are available. 1