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<p><strong>Objective: </strong>The objective of this thesis is to identify the approaches to patient-centered care provision currently employed by clinicians and to identify patient perspectives of patient-centeredness in relation to pain and disability following distal radius fracture. This thesis includes a scoping review of patient-centered care frameworks and models, as well as a prospective cohort study.</p> <p><strong>Rationale: </strong>Patient-centered care provision has been linked with positive health outcomes, improved patient satisfaction, and reduced health costs. A uniform approach to patient-centered care in rehabilitation has yet to be developed primarily due to the breadth and scope of practice. Understanding current approaches to patient-centered care and patient perspectives on this care can serve as a foundation to future discussions on the development of a rehabilitation-specific approach to patient-centered care provision.</p> <p><strong>Data sources: </strong>Frameworks and models of patient-centered care provision were located via electronic database searches. The extracted frameworks and models were compared based on how they described strategies on achieving the three tenets of patient-centered care: communication, partnership, and health promotion. A prospective cohort study provided patient perspectives on patient-centeredness, pain, and disability following distal radius fracture at baseline and at three months post distal radius fracture in 129 patients.</p> <p><strong>Methods: </strong>Frameworks and models on patient-centered care provision were extracted from articles and placed in data summary tables for comparison and review. Information on how these frameworks and models described strategies for communication, partnership, and health promotion was collated and reviewed. The patients’ perceptions of patient-centeredness, pain, and disability were determined from responses to the Patient Perceptions of Patient-Centeredness Questionnaire and the Patient Rated Wrist Evaluation. Outcome measure responses were analyzed to measure change over time (Wilcoxon Rank Sum and T-Test analyses) and to identify relationships (Pearson correlations).</p> <p><strong>Results: </strong>The scoping review found 19 articles, from which 25 patient-centered care frameworks or models were identified. All frameworks and models reported strategies on achieving effective communication, partnership, and health promotion. The prospective cohort study revealed significant correlations between patient perspectives of patient-centeredness and pain and disability following distal radius fracture. This suggests that positive experiences with patient-centered care provision are correlated with reduction in pain and improvement in function following an acute orthopaedic injury.</p> <p><strong>Implications: </strong>Until a rehabilitation-specific approach to patient-centered care provision is developed, rehabilitation clinicians can be confident that selection of one of the currently employed frameworks or models of patient-centered care will reflect the three tenets of patient-centered care provision. Adopting one of these patient-centered approaches to care provision likely will result in positive health outcomes.</p> / Master of Science Rehabilitation Science (MSc)

Bakgrund: Kroniska venösa bensår är en vävnadsskada i form av svårläkta hudsår som är lokaliserade nedanför knäleden och är orsakade av försämrat blodflöde i venerna. Trots att många människor drabbas av återkommande, smärtsamma och resurskrävande sår är de en medicinskt lågprioriterad grupp. Syfte: Syftet var att beskriva hur det är att leva med venösa bensår. Metod: En litteraturöversikt baserat på tio vetenskapliga originalartiklar. För artikelsökningen använde vi oss av databaserna Cinahl Complete och PubMed. Analysen utfördes inspirerad av Fribergs metod. Resultat: Analysen av artiklarna ledde till tre temaområden: somatiska besvär, psykosocialt lidande och omgivningens förhållningssätt Slutsats: Personer med bensår upplever betydande fysiskt och emotionellt lidande, inklusive smärta, skamkänslor och social isolering. Dessa patienter är beroende av vårdpersonal och anhöriga, och behöver en holistisk vård med fokus på både såret och den mänskliga aspekten. Ytterligare forskning behövs särskilt kring relationen mellan bensårspatienter och deras närmaste familj. / Background Chronic venous leg ulcers are tissue injuries in the form of hard-to-heal skin sores located below the knee, caused by impaired blood flow in the veins. Despite affecting many individuals with recurrent, painful, and resource-intensive sores, they are a medically low-priority group. Aim The aim was to describe what it is like to live with venous leg ulcers. Method A literature review based on ten scientific articles. The databases Cinahl Complete and PubMed was used in search for the articles. The article analysis was based on Friberg's analysis model. Results The analysis of the articles resulted in three thematic areas: somatic symptoms, psychosocial suffering, and the attitudes of the surroundings. Conclusions Individuals with leg ulcers experience significant physical and emotional suffering, including pain, feelings of shame, and social isolation. These patients depend on healthcare professionals and relatives, requiring holistic care that addresses both the wound and the human aspect. Further research is particularly needed regarding the relationship between leg ulcer patients and their immediate family.

Digitaliseringen har drivit utvecklingen av nya kraftfulla informationssystem med potential att effektivisera sjukvården. Internet har blivit en primär källa för människor att söka hälsorelaterad information och vårdsektorn står inför utmaningen att utveckla digitala system som fokuserar på patienten och dennes välmående. Den här undersökningen har genomförts för att besvara hur eHälsotjänster kan designas för att stödja en personcentrerad vård. Det gjordes med hjälp av en designorienterad ansats och resulterade i fyra designriktlinjer som beskriver hur patienters behov för översikt, kontroll och anpassning av behandlingen bör bemötas. De fyra designriktlinjerna har implementerats i en prototyp som har validerats och utvärderats. Undersökningen har bidragit med ökad kunskap kring hur eHälsotjänster kan designas för personcentrerad vård och har därmed besvarat undersökningens frågeställning. / Digitization has driven the development of new powerful information systems, with the potential to improve the efficiency in the healthcare system. The Internet has become a primary source for seeking healthcare related information and therefore the healthcare sector are facing a challenge with developing digital systems with person-centered focus. This study has aimed to answer the question “How can eHealth solutions be designed to maintain a person centeredness in the healthcare”. The study has used a design-oriented approach that resulted in four design guidelines that address patients needs for an overview, control and adaption of the content in their treatment. The design guidelines describe how eHealth can be designed for person-centered care and the guidelines represent the results that was identified in the study. The four guidelines have been applied in a prototype, and evaluated by different test persons. The study showed that the guidelines will contribute to increased knowledge about how eHealth can be designed for person-centered care and have given an answer for the research question.

Problem-based learning (PBL) was developed for use in medical education to incorporate more active, learner-centered instruction. Central to problem-based learning is the problem, which in medical education is usually case a case presentation, revealed in stages to allow learners to form and research learning objectives. The purpose of this study was to identify themes present across the PBL cases, including the patient-centeredness of the cases. Content analysis was used to examine 62 PBL cases that comprised the first and second years' core curriculum at a public medical school. The cases included a patient population similar to the local population, but care was more hospital-centric than would be expected from the actual patterns of medical utilization in the United States. Analyzing along two axes of patient-centeredness, the PBL cases demonstrated a good understanding of the patient (knowing the patient), but other qualities such as shared decision making was not as exemplified. Medical educators can use the results to understand elements that contribute to patient-centeredness and apply the analysis framework to evaluate future cases.

BACKGROUND:Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately.METHODS:From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation.RESULTS:The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains.CONCLUSIONS:This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.

This study aimed to understand how the identity of Manitobans with early malignancy is affected through diagnosis, decision making and treatment. Using grounded-theory methodology, semi-structured interviews were conducted with 18 adult patients with early breast, colon, lung, prostate and gynecological cancers, before and after adjuvant treatment decision making. 15 adult friends and family members were also interviewed. Significant findings include: 1) After diagnosis, the “cancer identity” emerged as a new aspect of the patient’s identity; 2) Establishing a post-diagnosis routine was a significant source of distress for patients; 3) Ability to re-establish routine post-diagnosis may be enhanced by providing earlier notification of medical appointment times and information regarding how different treatment options will affect the patient’s identity. This study provides new insight into the experience of patients with malignancy in Manitoba. Additionally, it presents recommendations, based on the insights and concerns of its participants, for improving the cancer journey of Manitobans. / May 2017