Relationship-centered Care

All illness, care, and healing processes occur in relationship—relationships of an individual with self and with others. Relationship-centered care (RCC) is an important framework for conceptualizing health care, recognizing that the nature and the quality of relationships are central to health care and the broader health care delivery system. RCC can be defined as care in which all participants appreciate the importance of their relationships with one another. RCC is founded upon 4 principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable. In RCC, relationships between patients and clinicians remain central, although the relationships of clinicians with themselves, with each other and with community are also emphasized.     

Family Care

Ohne Zusammenfassung     

The Role of Primary Care Physicians in Cancer Care

BACKGROUND  The demand for oncology services in the United States (US) is increasing, whereas a shortage of oncologists looms. There is the need for a better understanding of the involvement of primary care physicians (PCPs) in cancer care. OBJECTIVE  To characterize the role of PCPs in cancer care, compare it with that of oncologists, and identify factors explaining greater PCP involvement in cancer care. DESIGN  National survey of physicians caring for cancer patients conducted by the Cancer Care Outcomes Research and Surveillance Consortium. PARTICIPANTS  1694 PCPs; 1621 oncologists. MEASUREMENTS  Questionnaires mailed during 2005 and 2006 examined the participation of physicians in 12 aspects of care for cancer patients. MAIN RESULTS  Over 90% of PCPs fulfilled general medical care roles for patients with cancer such as managing comorbid conditions, chronic pain, or depression; establishing do-not-resuscitate status; and referring patients to hospice. Oncologists were less involved in these roles. Determining the treatment preferences of individual patients and deciding on the use of surgery were the only cancer care roles in which ≥50% of PCPs participated. Twenty-two percent of PCPs reported no direct involvement in cancer care roles while 19% reported heavy involvement. PCPs who were aged ≥50 years, were internists or geriatricians, taught medical students, saw more cancer patients, or experienced referral barriers fulfilled more roles. Rural practice location was not associated with greater PCP involvement in cancer care. CONCLUSIONS  PCPs across the US have an active role in cancer patient management. Determining the optimal interface between PCPs and oncologists in delivering and coordinating cancer care is an important area for future research.     

Medical Care for people in Residential Aged Care Services

This Position Statement represents the views of the Australian Society for Geriatric Medicine. This Statement was approved by the Federal Council of the ASGM on 8 October 2001. The preparation of this paper was coordinated by Dr Sam Scherer. 1. People are rarely admitted to residential care services for social reasons alone. Dementia, chronic illness and physical disability are the major determinants of admission, and compulsory pre‐admission assessments ensure that this is so. Many among the 140,000 people currently living in Commonwealth subsidised residential aged care services have complex medical service needs, and augmentation of the current medical service model is required if these needs are to be met. 2. Two decades of separate reform processes in residential aged care and general practice in Australia have resulted in significant advances in both fields, but the medical service needs of people in residential care have largely been neglected by policy makers from both the residential care and general practice sectors. 3. For the physical and mental health of residents there is a need for access to a broad range of integrated high quality health services including, but not limited to, gerontic nursing, primary care medicine, geriatric medicine; psychiatry of old age; palliative care medicine; dentistry; optometry and ophthalmology; physiotherapy; occupational therapy; speech pathology; podiatry; audiology; dietetics; and psychology. 4. Many common conditions of residents including behavioural symptoms of dementia; chronic pain; depressive disorders; urinary incontinence; hip fractures risk; skin ulcers; cardiorespiratory conditions and palliative care needs; require the development, institution and adherence to multidisciplinary clinical practice guidelines and valid outcome indicators. Therefore a collaborative inter‐professional mechanism for integrated guideline development must be established for this population. 5. People resident in Commonwealth subsidised services should retain access to regional State and Territory‐funded services. Specialist multidisciplinary services should establish supportive relationships with residential services in their regions, and provide individual consultations (on site if necessary), on referral by general practitioners. Aged care and aged psychiatry assessment and treatment services; memory clinics; regional continence services; falls and balance clinics; movement disorder clinics; pain management services; wound management services; and community health centres; all have expertise pertinent to the needs of services and residents. 6. At the level of the facility some form of organisation of medical service is required. Doctors are otherwise unable to conduct peer review activities and participate in multidisciplinary policy and procedure development. If this is economically impractical in each facility, it should be achievable under the auspices of local Divisions of General Practice. 7. At the sector level there is a need for the establishment of a medical special interest group, dedicated to promoting high quality medical care for the resident population, in which the Australian Society for Geriatric Medicine should have a major role. This body could progressively establish education and training requirements for recognition of competency in residential care medicine. This recognition could become an entitlement to a remuneration margin, thereby exposing the sector to a competitive market of interested and skilled medical providers. 8. The Australian Society for Geriatric Medicine believes that the matter of medical service provision in residential aged care requires urgent collaboration between Commonwealth, State and Territory ministerial portfolios and sections of the bureaucracy that are responsible for primary care; specialist medical services, and residential aged care, in order to establish to whom the reform mandate belongs; and to bring the medical and sectoral stakeholders together to begin the process of reform.