Improving Doctor Patient Communication

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J Med Syst (2009) 33:155–162
DOI 10.1007/s10916-008-9175-3

ORIGINAL PAPER

Improving Doctor–Patient Communication: Examining
Innovative Modalities Vis-à-vis Effective Patient-Centric
Care Management Technology
Gerald-Mark Breen & Thomas T. H. Wan &
Ning Jackie Zhang & Shriram S. Marathe &
Binyam K. Seblega & Seung Chun Paek

Received: 28 February 2008 / Accepted: 12 May 2008 / Published online: 5 June 2008
# Springer Science + Business Media, LLC 2008

Abstract This analysis investigates what patients and
practitioners can do to improve their interactive communications to achieve optimal patient-centric (PC) care. One
goal of this clinical practice approach is to improve patient
satisfaction, compliance, and outcomes. The mutual responsibilities required of both the patients and practitioners
to attain PC care are discussed. Innovative, information
technology techniques in the healthcare environment in
general and in care delivery in particular are explored.
Practitioner-to-patient encouragement vis-à-vis self education on their conditions is also provided.
Keywords Clinics . Doctors . E-health .
Information technology . Health care . Hospitals .
Management . Nursing homes . Patients .
Patient-centric care practice . Telemedicine

G.-M. Breen : T. T. H. Wan : N. J. Zhang : B. K. Seblega :
S. C. Paek
Department of Public Affairs,
University of Central Florida,
Orlando, FL, USA
S. S. Marathe
College of Health and Public Affairs,
University of Central Florida,
Orlando, FL, USA
G.-M. Breen (*)
Doctoral Program in Public Affairs,
College of Health and Public Affairs,
University of Central Florida,
3280 Progress Drive,
Orlando, FL 32826, USA
e-mail: [email protected]

Introduction
The purpose of this exploratory analysis seeks to fundamentally investigate what medical patients and practitioners
can do to improve their interactive communications to
achieve optimal patient-centric care. Patient-centric care
refers to clinical treatment, provided by medical practitioners, that focuses on and respects patients’ personal
preferences, desires, and values. Because this style of
treatment “centrally” concentrates on the patient, clinical
decisions are driven and are based primarily on what the
patient wants and believes he or she needs. One primary
goal of this type of clinical practice is to improve patient
satisfaction, compliance, and outcomes. However, a key
component to achieving patient-centric care requires that
the patient be educated and articulate regarding his or her
conditions and preferred treatments so that the practitioner
can justifiably respect and follow the patient’s wishes. As
such, this study is organized in the following format. First,
an extensive overview and theoretical discussion of what
patient-centric care encompasses are provided. What then
follows is a section that discusses the mutual responsibilities required of both medical patients and practitioners to
attain patient-centric care. After addressing the necessary
elements involved in achieving patient-centric care, a
section exploring innovative, information technology (IT)
techniques in the healthcare environment in general and in
care delivery in particular are explored. The purpose of this
particular discussion is to demonstrate how specific
information technology methods may improve and increase
the accessibility of viable and educational resources for
practitioners and patients, a means to enable and facilitate
patient-centric care. Subsequently, a brief overview of the

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importance of practitioner-to-patient encouragement toward
self-education on their conditions is provided, a significant
way to more effectively engage the patient in the patientcentric care model approach. Finally, a discussion section,
along with suggestions for future researchers interested in
healthcare technology, informatics, and improving healthcare delivery services, is presented.

Literature review
Patient-centric care: An overview
In recent years, many medical practitioners, in clinical
practices, have started to emphasize and seriously consider
patients’ wishes and preferences when deciding how to
treat them [1–6]. Clinical care quality—a highly researched
area in the fields of health communication, medicine, and
healthcare delivery [7–10]—consists of six distinct
domains, one of which is germane and includes “patientcentered” care (or more commonly referred to as patientcentric care; this phrase, “patient-centric care”, will be used
throughout this analysis). The Institute of Medicine [11]
refers to patient-centric care as the delivery of medical care
to patients that fundamentally respects and responds to
individual patient preferences, wishes, and values, while
ensuring that patient values direct and pilot all clinical
judgments and decisions. In line with communication
accommodation theory—a notion positing that humans
seek to adjust and change their styles and approaches of
communicating in order to match that of their interactor(s)
[34]—the goal of the physician is to make sense of and
“interact” with the patient, using an interpersonal combination of personal exploration, sensitivity, accommodation,
rapport, and trust. Achieving such an effective relationship
may lead to improved patient outcomes in general [4].
The Picker Institute—a globally recognized leader in the
fields of scientific measurement, enhancement of the patient
experience, and the promotion of patient-centric care—
established eight dimensions of patient-centric care [1, 8].
These dimensions include the following: (1) respect for the
patient’s values, preferences, and expressed needs; (2)
information and education; (3) access to care; (4) emotional
support to relieve fear and anxiety; (5) involvement of
family and friends; (6) continuity and secure transition
between healthcare settings; (7) physical comfort; and (8)
coordination of care. According to White and Roughan [5],
patient-centric care highlights and gives emphasis to the
experiences of the patients and their interpretations of their
own physical conditions and wellbeing. Basically, the
fundamental tenets of patient-centric care management
hinge on the development and enhancement of interpersonal continuity of care and patient-provider communication.

J Med Syst (2009) 33:155–162

Taking a more theoretical perspective, social presence
theory, a notion that stipulates that a sense of awareness
of the presence of an interaction partner is needed in order
to achieve relational closeness [35], demonstrates how the
doctor–patient relationship needs to be personably close for
patient-centric care to effectively exist.
The Institute of Medicine [11] also provided a series of
recommendations for primarily healthcare institutions,
stating the following: “all healthcare organizations, professional groups, and private and public purchasers should
pursue six major aims; specifically, healthcare should be
safe, effective, ‘patient-centric’, timely, efficient, and
equitable”. In light of this background information related
to patient-centric care, there is only a dearth of research that
has been conducted that specifically addresses ways in
which patients can enhance their communication with their
medical practitioners in an effort to improve the patientcentric care that their healthcare practitioners deliver.
In this analysis, methods of improving communication
between patients and practitioners pertaining to patientcentric care are explored. More specifically, the goal strived
for in this analysis aims to enhance overall clinical care
quality by investigating strategies and methods to develop
and enhance patient-centric care.
Practitioners and patients: Mutual responsibilities
toward patient-centric care
According to Steinberg [4], physicians who provide patients
with customized healthcare communications—and those
communications must be credible, clear, and actionable—
can facilitate patients’ abilities to select and communicate
more appropriate and self-centric healthcare recommendations to their physicians. This, likewise, can increase
physicians’ approval ratings of patient-centric care practices
[2, 5]. While physicians generally support patient-centric
care, only about 22% of the general medical doctor
population sufficiently integrates such strategies and
approaches into their routine practices [12]. As such, we
are left with a rather significant research question: why is
the other 78% of general medical doctor population not
embracing or employing this model in their practices?
Investigating and ascertaining this inquiry could more
clearly elucidate ways in which patient-centric care could
be more broadly integrated into clinical practices. One
barrier or issue to more wide-scale implementation of such
patient-centric care may lie with the patient. Because it is
evident that patient-centric care values the patient’s wishes
and seeks to care for the patient while constantly
considering how to specifically please and make assessments according to what the patient desires [2, 4, 5, 7, 9],
the patient must also take and exert a proactive role in the
doctor–patient interaction. Essentially, the patient and

J Med Syst (2009) 33:155–162

physician need to equally devote and adhere to the
guidelines of “patient-centric” care vis-à-vis effective
delivery of this practice. The patient, given various
demographic characteristics, may impede the ability to
engage a patient-centric care approach, rendering the
physician disinclined to elect patient-centric practices.
Interestingly, one of the most significant findings to be
revealed in medical interaction research is that patients’
communicative behaviors affect and shape those of doctors
[6]. In an astute and largely practical linguistic archetype of
patient participation in care, Street [13] proposed that
explicit and particular types of speech on the patient’s part
(making inquiries, displaying anxiety, taking on an assertive approach to communicating, and sharing real-life
examples of health-related episodes) influence the medical
practitioner’s behavior and the situational elements of the
doctor–patient clinical encounter. Uncertainty reduction
theory, a notion that suggests that humans instinctively
evaluate and observe others for the purpose of understanding and identifying patterns of behavior [36], reflects the
kind of interpersonal activity needed between the doctor
and patient so that clear recognition and predictability of
both parties can be established. For the doctor, “knowing”
the patient may influence the decision on whether patientcentric care is appropriate.
Similar to other forms of communicative exchange, the
medical interaction is a dynamic experience that develops
and transpires according to the uniqueness and personalities
of each interactive participant (e.g., attitudes, goals, and
linguistic skills), the partner’s conduct, and customs or rules
governing suitable conversational behavior (i.e., turntaking, topic development) [14]. The transactional model
of communication, a theoretical construct of communication that accounts for continuous message exchange and
deciphering between a sender and receiver [33], reflects the
interactive style between doctors and patients. In addition,
social penetration theory, which posits that as relationships
develop, communication moves from a superficial, nonintimate position to one that is deeper and more personal
[37], echoes the direction both the practitioner and patient
must mutually take toward achieving a strong communicative relationship. This model and theory also seem to
demonstrate how physicians may decide that, after close
observation and interaction with a particular patient,
patient-centric care approaches may or may not be suitable.
It is also crucial to understand various attitudes physicians in general carry toward patient-centric practices. By
the same token, recognizing why some physicians either
adopt or reject such patient-centric practices is critical to
understanding the strengths and weaknesses involved in the
practices themselves [2, 4, 5, 7, 12]. Medical providers are
highly responsible for taking their own steps and initiatives
toward ensuring that patient-centric care can be and is

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performed effectively and appropriately [4, 5]. Moreover,
such patient-centric care requires significant contributions,
efforts, and strides from the providers as well as the
patients. Interestingly, approximately 42% of primary care
providers (PCPs) investigated across the country stated that
it was very or somewhat easy for them to produce and
maintain disease registries, whereas a mere 18% of the
same PCP population on average indicated the same about
generating lists of patients who receive complicated,
concomitant medication protocols that require more indepth, meticulous, and dedicated follow-up care [1].
Another issue that arises here is that PCPs face numerous
obstacles in their choices to either adopt or reject patientcentric care practices, particularly due to reasons related to
a lack of training, a paucity of understanding in health
informatics and computer system functions, generalized,
insufficient knowledge, and the costs involved in conducting such complex care practices. In a similar train of
thought, a care management team may also need to be used
to perform coordinated services that cover assessment, care
planning, care evaluation and outcome tracking. Efficiencies are gained where services are provided to groups of
clients needing the same or similar benefits (education,
exercise, etc.). Individual needs are assessed in the context
of individual care and larger group care. Such intricate care
processes can be intimidating or excessively time-consuming for physicians, yielding a sense of discouragement from
pursuing this clinical practice.
To encourage and bring promise for future clinical
expectations regarding patient-centric care practices, Audet,
Davis, and Schoenbaum [1] assert that, “with the right
knowledge, tools, and practice environment, and in partnership with their patients, physicians should be well
positioned to provide the services and care that their
patients want and have the right to expect” (p. 755). Thus,
at the very least, many of the barriers that impede more
widespread adoption of patient-centric care practices could
be transcended or circumvented if the right resources are
made available, identified, and strategically incorporated
for clinical implementation.
Relationships between communication and outcomes
Two specific studies [see 15, 16] have revealed noteworthy
findings in correlating increased patient-clinician communication and patient self-reporting of positive outcomes
(including those patients with chronic illnesses). With
respect to the first study, a chronic disease self-management
program constructed to exclusively satisfy the needs of a
heterogeneous cluster of chronic disease patients, including
those with several co-morbid pathologies, was determined
to be practical and advantageous beyond standard care [15].
Further, as pointed out by White and Roughan [5], patient-

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centric outcomes can also strengthen and uphold disease
management systems at the point of care.
The second study examined chronic care clinics (involving standardized assessments, clinical encounters with the
PCP, nursing staff, and a main pharmacist). In this case, it
was uncovered that the intervention group received far more
recommended preventative practices and demonstrated
greater improvement in two of the primary health status
indicators. Relative to control patients, intervention patients
on average experienced a few more primary care visits but
notably less specialty and emergency room visits [16].
With patient-centric care, since every patient is unique
and different, each patient receives individualized and
customized treatments, education, and advice by their
medical providers, according to the specifics of their
conditions, their preferences and wishes, and how they
perceive they should be appropriately treated for “personally” optimal results [2, 4]. But communication on the
patient’s part needs to be well-informed, proper, and
efficient [12]. Because patients oftentimes do not effectively share their wishes, specific concerns, and desires for
preferred care with their medical practitioners [6]—to the
extent that the medical practitioners “cannot” fully take
heed to what their patients state or request—this dilemma
compromises the practitioners’ ability and desire to abide
by and respect their patients’ individual care needs and
wishes. Especially in considering ethnic diversity among
patients, according to Johnson et al. [17], African Americans consistently evaluate their clinical encounters with
medical practitioners as less participatory than Caucasian
Americans. In addition, medical practitioners are more
prone to be more vocally domineering and less patientcentric with blacks relative to whites [17]. Thus, patientcentric care approaches need to be tailored according to
ethnic background, as specific preferences for care could
considerably vary across ethnicities and cultures.

Information technology in healthcare delivery:
Resources to improve communication
between practitioners and patients
Technology has become a banal and pervasive resource
throughout all public and private spheres, particularly in
homes and in medical clinics [3–7, 10, 12, 18, 19]. Breen
and Zhang [32] have asserted that technology theories
justify and confirm the practicality of online medical
resources in facilitating healthcare services in general. For
instance, Breen and Zhang [32] identified that the technology acceptance model—which puts forth that the perceived
usefulness of a specific form of technology influences one’s
motivation to integrate such a technological system – serves
as an explanation as to the applicability of technology in the

J Med Syst (2009) 33:155–162

healthcare field in general and in doctor–patient interactions
in particular. Furthermore, Wan [20], an expert in healthcare
informatics (HI), asserts that HI, a field that combines
health science, computer science, information science,
decision science, and management science to manage and
distribute data, information, and knowledge in healthcare
practice and management, facilitates the integration of data,
information, and knowledge to assist medical practitioners,
patients, and pertinent administrators and executives in their
decision making in all functions and situations. Eichhorst
[7] suggested the adoption of a centralized, longitudinal
approach to patient data as a feasible strategy for healthcare
organizations, particularly nursing home facilities. Applying this patient-centric care approach—utilizing IT—
enables proactive enhancements that are difficult to attain
via an interfaced network of specialized systems. The most
essential benefit from this approach is the effortless ability
to examine a broad range of data in both care settings and
administrative operations. Interestingly, the employment of
this IT approach to patient data likewise provides the
simultaneous advantages of flexibility and sustainable,
progressive development [2, 7]. Furthermore, Montreuil
and Garon [3] posed a similar model of patient-centric care,
applying a distributed network, one that has the ability to
advance health and social services delivery. By the same
token, the use of an electronic medical record system can
minimize client frustration with the medical intake process.
The same provider could see the patient at a satellite office,
during a home visit or in the hospital, and have immediate
access to all the information to make assessments and
recommend treatment. In simple terms, medical records will
not be lost. In a similar vein, Audet, Davis, and Schoenbaum
[1] note that approximately 54% of all physicians post
reminder notices to their patients concerning preventative
or follow-up care. A vast majority, or approximately 83%,
of PCPs indicated they approve and support the sharing of
medical records with patients [12]. Nevertheless, on-site
wait time, telephone wait time, and refill and referral wait
times can be reduced as a result of improved, secure
communication via email, instant messaging, and file
sharing.
One possible model for patient-centric care—only now
proposed for the first time in this analysis—could focus on
elements known to be strengths of community health
centers. For instance, this one particular model, as shown
in Fig. 1, demonstrates a patient-centric care plan that
recognizes the benefit of revolving service around the
individual client’s needs. The patient is nestled in the field
of his or her healthcare advocate, a technologically wellconnected, medical-social navigator trained to guide the
patient through his or her healthcare choices and facilitate
coordination (inside and out) of the care advised by the
provider team. This advocate, who is well-equipped in

J Med Syst (2009) 33:155–162

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Fig. 1 ICMP-based care model

healthcare information technology, is firmly seated between
both the client’s sphere and the realm of the health center,
where he or she can coordinate care needs, such as
appointments, group education, and childcare referrals.
The health center staff and resources are encompassed by
the larger community of specialists and other safety net
agencies. Nevertheless, there are four common threads to
this model that differentiate it from other private and
Medicaid-managed care products. All four characteristics
are drawn from health center research that identified
distinctions that influence a center’s ability to provide
higher quality health care to more satisfied clients. These
factors, as illustrated and running through each sphere of
the model, include accountability, partnership, continuity,
and choice.
The IT tools that extend throughout all the model
spheres are designed to develop, deploy, maintain, and
evaluate this patient-centric managed care plan across risk
pools. Service delivery should be improved via technology
with the employment of information technologies, such as
expanded electronic medical records, web-based access,
digital record archiving, e-pharmacy, e-referrals, integrated
billing and posting. Technology should improve healthcare
outcomes through knowledge-based patient care management by facilitating client access to services, expanded
provider linkages, reduced fragmentation, and improved
system efficiencies. This idealistic design, based on a
collection of successes, may serve as a state model for
Medicaid managed care.
Another IT support mechanism that may aid in patientcentric care services is the use of e-health (i.e., WebMD.
com, Medlineplus.gov, Medscape.com, and Mentalhelp.

net), or Internet-based web sites containing exclusively
medical, diagnostic, treatment, and pharmaceutical information [10, 18]. E-health offers physicians—and also of equal
importance, patients—the ability to access information
related to specific medical conditions, in order to acquire
education and a greater knowledge level of the particular
malady that might be or is ailing the patient(s) [21]. When
patients take the steps to proactively seek information
regarding their illnesses, they are in a more advantageous
position to share their specific knowledge and concerns
with their doctors [6]. Then, as doctors become aware of
these issues that are provided directly from the patients, a
greater sense of patient-centric care can result. For example,
Lee et al. [19] conducted a study to determine how
hospitals providing supplemental, Internet-based e-health
resources (web sites for obtaining medical information) for
diabetic patients, would enhance patients’ abilities to
manage, control, and become more generally educated on
their diabetic conditions, thereby leading to greater patient
outcomes. Research has also shown that physicians who
offer their additional time and efforts toward patients can
lead patients to display various, positive cognitive-affective
responses toward their doctors, such as trust (as opposed to
mistrust) and signs of satisfaction (rather than dissatisfaction) [4]. Such doctor–patient relational success could be
based on the tenets of social penetration theory [37] and
social presence theory [35] (as previously discussed), as
these theories explain how the trust and satisfaction felt by
the patient may be a result of the physician striving for
relational closeness with the patient.
The literature also abundantly confirms a clear, positive
correlation between increased, quality communication and

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increased feelings of satisfaction and trust between medical
practitioners and patients [6, 10, 22–24]. What is also
pointed out in the literature is that patients actively using
patient health records (PHRs) become advanced participants in medical interactions. Thus, patient participation
boosts perceived patient safety. The US Department of
Health and Human Services supports PHRs, as electronic
health records can largely assist in the proper administration
and intake of medications, maintain continuity of care,
reduce repetition of unnecessary testing, and lower undesirable drug interactions and allergic reactions. As such, PHRs
may serve as another technological tool to encourage wider
acceptance of patient-centric care practices by physicians.

The influence of physician encouragement:
Toward improving patient self-education
and communication with their providers
A large percentage of complex-care patients, and similar
patients who require such a vast mixture of care, generally
do not just independently seek out supplemental information on their delicate pathological conditions. Typically,
advice and recommendations to self-educate are given by
their medical providers. In addition, medical providers can
furnish specific instructions to their patients on where to
electronically or physically obtain this information. Making
the patient “educated” and more knowledgeable, while
simultaneously delivering normal medical interventions
from hospitals and/or clinics, enables patients to better
communicate their informed understandings and wishes to
the providers (e.g., regarding their desired and needed
patient care) [2, 6, 25]. Thus, this facilitates and makes
more possible the patient-centric medical care approach.
Overcoming financial boundaries to patient self-education
Millions of US residents cannot afford to incur the expenses
of medical treatment, prescriptions, or preventative health
care [6]; many US residents are below federal poverty
levels, are minorities with insufficient care access, and are
elderly with minimal resources [6, 26]. Thus, their abilities
to gain access to resources that can educate them regarding
their medical conditions become difficult and sometimes
unachievable. In these cases, the practitioners should
suggest methods that these patients can use to circumvent
the financial barriers that prevent them from self-education.
For instance, indigent patients with chronic medical
problems can visit libraries to use their [the library] Internet
terminals to access medical information online [27]. Or,
physicians can provide pamphlets or register their patients
in programs that send free information via postal service to
the patient’s residence. State and county health departments

J Med Syst (2009) 33:155–162

are also available and provide discounted pricing for
healthcare services to those who fall below certain income
or socioeconomic levels [3]. Thus, despite financial barriers
that do exist that may discourage patients to seek out
educational resources regarding their medical conditions,
free or highly discounted resources are in fact available that
may aid these special populations in their quest to selfeducate themselves on their illnesses. Further, more
physicians need to take this responsibility to encourage
their patients that, regardless of whatever barriers may
affect patients’ abilities to learn about their medical
conditions, there are multiple ways to potentially overcome
them and obtain the information they need to ensure proper
care and self-monitoring. Gaining access to this information
may serve to increase acceptance of patient-centric care
practices by physicians, as the patients should become more
inclined to communicate in differential diagnoses and
treatment options.

Discussion and Conclusion
Discussion
What this fundamental, exploratory analysis has demonstrated is that optimized patient-centric care requires that
medical patients must improve communications with their
medical practitioners; conversely, medical practitioners also
need to improve their communications with their patients to
achieve patient-centric care. Too, this analysis has examined how this special clinical practice approach, that is,
patient-centric care, is designed to and can significantly
improve patient satisfaction, compliance, and outcomes.
Yet, a major responsibility to ensure sound quality patientcentric care not only lies with the physician, but patients
must also be properly educated, motivated, and sufficiently
articulate with their physicians regarding their medical
conditions and preferred treatments. In doing so, the
physicians can justifiably observe and follow how the
patients wish to be treated. Patient-centric care stipulates a
two-sided, mutually involved practice, requiring significant
contributions from both the practitioner and patient.
Further, information technology in the healthcare environment and for care delivery purposes can be highly
useful. For instance, patient-centric care can be facilitated
by obtaining medical information from e-health sites. Such
sites, including WebMD.com, are valuable educational
resources for practitioners and patients, and can serve to
better enable and facilitate patient-centric care. What was
also covered, and carries high importance in ensuring the
most effective engagement of patients for patient-centric
care purposes, is the need for practitioner-to-patient
encouragement toward self-education on their conditions.

J Med Syst (2009) 33:155–162

Physicians need to inspire and urge their patients to be as
knowledgeable as possible on their illnesses and common
treatments so that the patients can convey reasonable and
justifiable wishes to their doctors for optimal patient-centric
care. Information technology is one such resource that may
help achieve patient education and increase the probability
of mutually agreeable patient-centric care between the
doctor and patient.
Practice implications
No matter what scenarios patients find themselves in
regarding their illnesses, the medical practitioners caring
for them should always leave some room for considering a
patient-centric care approach. Clearly, some cases in which
patients are cognitively impaired, or cannot justifiably
refuse or request certain treatments, must be recognized
by the physicians so that malpractice does not occur [9].
But cognizance and sound judgment on the physician’s part
should always be kept in mind regarding patient-centric
approaches to care delivery. Additionally, patients who
possess the knowledge and cognitive capacities to express
their wishes for their personal care to their doctors should
not be neglected or overlooked. The bottom line is that
patient-centric care is either a viable option for some or a
liability or improper approach for others.
Conclusions
Many conclusions can be drawn from this analysis. Yet, we
should go beyond conclusions and seek to identify
opportunities for future research and innovative clinical
practice techniques. One area for future researchers,
concerning the use of IT in the application of patientcentric care, is the need for establishing a federated datasharing network to facilitate efficient and effective use of
health service resources. For instance, one method could
apply IT-based care management technologies for improving patient-provider communication, continuity of care, and
outcome tracking. Both clinical and administrative decision
support systems could be designed, implemented, and
evaluated. The efficacy of an innovative delivery system
for community health—particularly for the indigent and
minority populations—could be demonstrated through a
randomized trial with multiple community health centers.
With respect to another area for future research, it might
prove interesting to explore more specified methods of
patient-centric care, depending upon the particular conditions and needs of the patients. For instance, in medical
cases in which the patients suffer from mental illnesses,
approaching patient-centric care might be more complicated.
It may be difficult for physicians to readily accept the wishes
of psychiatric patients regarding their unique care prefer-

161

ences, as these patients may not know what the best
treatments are for them. Hence, special caution should be
used on psychiatric or cognitively impaired patients with
various mental illnesses, as their abilities to think clearly and
accurately convey their wishes are compromised [28]. In a
similar vein, older patients suffering from dementia,
Alzheimers, and other forms of cognitive dysfunction, are
special populations they may not be well suited for patientcentric care. As such, similar caution should be exercised
by physicians who encounter and treat these types of
patients, especially if these patients express to be cared for
in a patient-centric manner.
Another research prospect concerns whether patientcentric care can be effectively administered to nursing
home residents. Because nursing home quality has been a
subject of governmental and healthcare concern for the past
several decades [29], discovering new technology, methods,
and management in quality improvement is important. As
such, it would be prudent to explore if various patientcentric care approaches would be feasible and beneficial in
this setting. As in hospital and other long-term care settings,
patient-centric care is considered promising because of its
attractive features, such as empowered patients in healthcare decision making and informed patients accessing
patient clinical data and provider performance data. In an
optimal patient-centric care situation, nursing home residents and family members should be informed and
involved in transitional care provided among hospitals,
nursing facilities and residential homes. However, there
remain many obstacles to patient-centric care in nursing
homes. For instance, Wan [30], also a specialist in the area
of nursing homes, stated that “90% of nursing homes have
too few nurses to provide even the most basic of care”
(p. 283). Thus, nursing shortage may limit nurses’ abilities
to execute or exercise efficacious patient-centric care,
given their excessive workload and high turnover rates.
Therefore, the implementation of patient-centric care not
only depends upon an increase in nurse staffing, but it
also relies on nursing home reimbursement and financial
performance. Nonetheless, one area where patient-centric
care might be of consideration in the nursing home setting
concerns residents’ choices regarding whether to accept or
reject the ingestion or usage of psychoactive medications.
According to Castle and Engberg [31], “evidence exists
that some nursing homes inappropriately use medications—
especially psychoactive medications” (p. 208). If medication errors or inappropriate distribution of medications are
occurring among such a delicate population, the wishes of
the resident, if the resident is cognitively intact, should be
respected and generally followed by the practitioners in
charge of treating those residents.
One first step in developing patient-centric care in a
nursing home scenario is to enhance current nursing

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practitioners’ education in defining and valuing residents’
decision making. The concept and best practice of patientcentric care in health care must be integrated into teaching
and training protocols. Since patient-centric care represents
two-way communication, resident education is equally
important and necessary. Residents should have the
knowledge to make decisions after they are aware of their
health status, diagnosis, and treatment choices. Yet, far
more research into this realm needs to be explored before
further postulations or recommendations can be made on
patient-centric care in the nursing home environment.
In conclusion, the application of patient-centric care
management should effectively utilize health information
technology and decision support systems so that evidencebased practice can be developed and may guide the
performance improvement in the delivery of both personal
and public health services.
Acknowledgement This research is, in part, supported by the
National Institute of Nursing Research, National Institutes of Health
under research grant number: R01 NR008226–01A1.

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