Joining healthcare professionals and older adults with chronic illness perspectives towards collaborative person-centered practice at an inpatient hospital department

The growing aging trend associated with a higher prevalence of chronic illnesses and increased vulnerability of older adults during hospitalization highlights the need for a person-centered approach in healthcare. This approach emphasizes patient involvement in the healthcare process, fosters shared decision-making and mutual understanding, and honors individual values, preferences, and beliefs. Despite broad consensus on the importance of adopting this clinical practice paradigm, its implementation remains challenging. Person-centeredness understanding of those involved in the therapeutic relationship may significantly impact the development of person-centered practice (PCP) in specific care settings. This study aims to compare and analyze the perceptions of the PCP among a multidisciplinary team and older adults with chronic illnesses hospitalized in a Portuguese internal medicine unit using the Person-Centered Practice Inventory (PCPI). PCPI is an instrument aligned with the theoretical elements of the Person-Centered Practice Framework (PCPF), offering an understanding of its practice, identifying areas of potential improvement, and designing specific interventions to elevate the PCP operationalization.

A quantitative, descriptive, cross-sectional approach was followed. A sociodemographic and professional questionnaire and the PCPI-Staff were used for health professionals. For older adults, a sociodemographic and health history questionnaire and the PCPI-Care were applied. Both versions of the PCPI evaluate the person-centered processes domain derived from the PCPF.  A descriptive analysis of the effect of different variables on each construct of the person-centered process was performed using an analysis of variance (ANOVA). The independent sample t-test was applied to compare health professionals' and hospitalized older adults' perceptions of care.

The results showed that the person-centered process dimension was positively perceived by health professionals (M= 4.08; SD= 0.62) and older adults (M= 3.92; SD= 0.47). For health professionals, the highest-scored construct was working holistically (M= 4.22; SD= 0.62), and the lowest was sharing decision-making (M= 3.91; SD= 0.72). Concerning older adults, the highest-scored construct was working with the person's beliefs and values (M= 4.12; SD= 0.51), and the lowest was working holistically (M= 3.68; SD= 0.70) and sharing decision-making (M= 3.78; SD= 0.60). A significant difference occurs in the perception of working holistically (t(273)= 6.12, p-value= <0.001) and engaging authentically (t(273)= 3.05, p-value= 0.03), showing differences in how care is delivered and experienced through the integration of physiological, psychological, sociocultural, developmental, and spiritual dimensions in a therapeutic relationship that should be dynamic and genuine.

No significant effect of the independent variables was found to influence the perceptions of any constructs in the person-centered processes domain in health professionals and hospitalized older adults. These results suggest that each person uniquely experiences person-centered processes through individualized therapeutic relationships rather than as a pattern of care shared by hospitalized older adults.

Differences in how working holistically and engaging authentically are perceived should propel health professionals to reassess their understanding of person-centered practice, seek guidance, and actively work to refine their approaches in these areas. This process can help align the perceptions of their work with patients' care experiences, promoting greater consistency between professional intentions and patient outcomes.