by Dr. Joel Lamoure
Official Citation for references:
Lamoure J., Stovel J., Piamonte M., Benbow S., Singh P., Steenstra J., Singh P., Moore K, Burgess S. The Collaborative Patient/Person-Centric Care Model (CPCCM) Introducing a new paradigm in patient care involving an evidence-informed approach. Canadian Healthcare Network. EPublished 7 March 2011. http://www.canadianhealthcarenetwork.ca/
Contact: jlamour@uwo.ca
"Patient care has traditionally been guided by the conventional paradigm known as the medical or biomedical... more
"Patient care has traditionally been guided by the conventional paradigm known as the medical or biomedical model, whose roots can be traced back to the era of reductionism and mind-body dualism, which separates the mental from the somatic. (Engel, 1977) In this model, disease is defined as a biophysical malfunction. (Engel, 1977) In the biomedical model, the goal of treatment is to correct the malfunction in order to cure the disease. (Engel, 1977) As such, this traditional medical model places the pathophysiology of the disease, objective tests, and therapeutic interventions at the centre of patient care. (McCollum, 2009) Such a model offers a one-dimensional approach to patient care that excludes the patient experience of illness and how this might impact other facets of the patient’s life (e.g., work disability, finances, social networks, etc.) because they are believed to lie outside of medicine’s responsibility and authority. (McCollum, 2009; Engel, 1977)
By incorporating other psychological (e.g., thoughts, emotions, behaviors) and social dimensions of the patient into the care plan, one moves towards the bio-psycho-social (BPS) model of patient care. (Phelps, 2009) The BPS model was first theorized by a psychiatrist, Dr. George L. Engel, in 1977. (Engel, 1977) In the BPS model, patient care is based on the belief that psychological and social dimensions also contribute significantly to human functioning within the context of disease or illness and, as such, need to be considered when providing care to a patient. (Engel, 1977) Specifically, the biological component examines the cause of the illness and how it affects the functioning of the body. (Engel, 1977) The psychological component of the model explores any potential psychological causes for the illness (e.g., lack of self-control, emotional stressors, negative-thinking, etc.). (Engel, 1977) Finally, the social component considers how different social factors (e.g., socioeconomic status, religion, culture, etc.) impact illness. (Engel, 1977) In order to address all aspects of this three-dimensional model, an integrated team approach involving allied healthcare professionals such as physicians, nurses, psychologists, pharmacists, social workers, and rehabilitation specialists are critical for ensuring that more comprehensive patient care is provided. (Phelps, 2009) Overall, the underlying premise of the BPS model is that the body and mind are intricately connected and what affects one will affect the other. (Halligan, 2006; Freudenreich, 2010) However, while this model advances patient care and can address the dis-ease that exists within the disease, it still does not encompass the patient as a “whole” and consider all the multitude of facets that make up the individual.
An alternative model to the biomedical and BPS model of care is the recovery model. In the recovery model, the patient is involved in a lifelong recovery process that involves a number of incremental steps across various facets of his or her life. (Turton, 2010) Moreover, the primary illness is seen as only one dimension in the patient’s recovery process. (Turton, 2010) Other key aspects of this model include negotiating treatment approaches between patients and practitioners such that the patient feels empowered. (Turton, 2010) Moreover, this model enables patients to regain their dignity and identity beyond the illness. (Turton, 2010) As such, this model takes the BPS model and advances it forward to include other patient dimensions in the provision of their care. Thus, the underlying ethos of this model for the patient is one of hope and optimism. (Turton, 2010)
A recent study conducted in ten European countries aimed to examine the recovery model of patient care in order to identify aspects of care that key stakeholders believed to be most important in the promoting recovery, specifically in patients with mental illness. (Turton, 2010) Eleven important domains of care identified by stakeholders in this study included: (1) social policy and human rights, (2) social inclusion, (3) self-management and autonomy, (4) therapeutic interventions, (5) governance, (6) staffing, (7) staff attitudes, (8) institutional environment, (9) post-discharge care, (10) caregivers, and (11) physical health care. (Turton, 2010) The authors also found that there was generally a high consensus between groups and countries with some modest differences in priorities noted. (Turton, 2010) Interesting, the most highly rated aspect of care was therapeutic interventions, a central piece of the more traditional medical model of care. (Turton, 2010) The authors suggest that stakeholders may still hold therapeutic interventions as the most important aspect of care because such interventions form the foundation and ‘raison d’être’ of health care. (Turton, 2010) Thus, it may be difficult for practitioners to step away from convention and embrace a new paradigm.
Incorporating various aspects of the BPS and recovery model of patient care, a patient-centered care (PCC) model has evolved over the last several years to replace the conventional biomedical model of care. (Laird-Fick, 2010) The Institute of Medicine (IOM) has stated that embracing a PCC model will help to close the “quality chasm” often present in the care provided to patients. (IOM, 2001) In a PCC model, the patient’s individuality is central. (Wolf, 2008) The patient has the right to have his or her needs, desires, beliefs, values, and goals respected and placed at the centre of the care plan. (Laird-Fick, 2010; Wolf, 2008) Such respect of the patient’s individuality is part of the team’s commitment to understand the patient’s perspective of his or her own health status and subsequent care. (Wolf, 2008) The underlying ethos of this model of care is that the patient has the right to respect, dignity, and care that focuses on the person and situation versus the disease process. (Wolf, 2008)
Our hypothesis is that the medical and bio-psycho-social models act as an essential foundation on which a more patient functionality centered model evolves: the Collaborative Patient/Person-Centric Care Model (CPCCM). This has a paradigm shift in the deliverables of patient care which involves talking to patients and family, listening to their desired outcomes, collaborating with allied health team members in order to help facilitate these patient goals, and finally formulating an individualized care plan that combines the patient’s wishes with the clinical endpoints derived from a uniform therapeutic thought process. The root of this theory is enmeshed in goal driven outcomes, as are the other models. However the goal is driven by the patient and then filtered through the professional lenses of the members of the treating team versus the converse. This evidence-informed versus evidence-based approach is more patient centric than when outcomes are determined independently by clinicians in a traditional hierarchical structure. This also allows the current structure to be realigned along a linear axis. (Lamoure 2008)" Joel Lamoure, Jessica Stovel, Matthew Piamonte et al.
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