Person-Centred Healthcare in Kugluktukby Nicola on 2015-05-23
Person-centered Healthcare in Kugluktuk
By Nicola Davies
Since doctors know what is best, patients are expected to listen to what they say. In reality, however, patients sometimes follow the doctor’s orders because they don’t know what their other options are. They follow orders not because they have full confidence in the decisions of the doctor, but because they don’t know what is going on with their health.
Person-centered healthcare is a relatively new concept that aims to address that problem. Its goal is to always include patients in making decisions related to their treatment. According to the Canadian Association for People-Centered Health (CAPCH): “People-centred care acknowledges that there’s a world of difference between ‘being cured’ and ‘being helped to feel whole’. People-centred seeks to do both.” In other words, it is care that not only aims to treat the illness, but at the same time ensures the patient feels comfortable and satisfied with how the treatment is received.
With person-centered healthcare, the patient is informed, involved and in control of their treatment. It provides the patient with the necessary knowledge about their condition and the treatment options available to them. Along with family members who can support them, the patient then partners with the physician in setting any health goals. Treatments are designed around the patient’s needs and concerns, and not the other way around. These concerns could be making the treatment manageable, improving one’s quality of life or extending one’s lifespan. Whatever the patients’ needs may be, the person-centered approach places those needs at the very centre of the decision-making process. Involving patients in the development of treatment plans has been found to empower patients and their family members. Patients are also more likely to follow their treatment plan, which helps in achieving a good health outcome.
Barriers to Person-centered Healthcare in Kugluktuk
Kugluktuk healthcare has to address several barriers before it can be open to the person-centered approach. Access to health information, for example, is a basic characteristic of the approach, but it can be a challenge for Inuit communities. Language barriers between patient and physician make the sharing of health information a problem. Non-local physicians sometimes also have a limited understanding of the Kugluktuk culture, making it difficult for patients to fully trust them.
Due to their geographical location, the Inuit population also has less access to healthcare professionals and health services as compared to the general population of Canada. According to the 2012 Aboriginal Peoples Survey, 10% of the Canadian population experienced a time when they felt they needed health care but were not able to receive it; however, for the Nunavut population, it was higher at 14%. The percentage of the Canadian population that consulted with a medical doctor in the last year was 79%, but it was only 59% for Inuit populations. According to the 2012 Canadian Community Health Survey, 85% of the Canadian population had a regular physician, but only 39% of Inuit said the same.
Communities like Kugluktuk get access to health services through nursing stations where outside physicians regularly visit. According to the Health Council of Canada, these stations have difficulty recruiting and retaining personnel. Most doctors are often available in regional centres near the southern part of Canada, which makes continuity of care very difficult. Cases of patients are passed from one doctor to next. Patients who requiring urgent attention need to travel to these regional hospitals just to see any available doctor.
Patients in Kugluktuk have limited access to health information and health professionals. As a result, they aren’t able to identify their needs, openly express their concerns and share in decision-making regarding treatment, which is a big concern since the patient is the one receiving it. The current state of Kugluktuk healthcare could benefit immensely from adopting a person-centered approach.
Introducing a Person-centered Healthcare in Kugluktuk
The person-centered approach will take time before it can be in full effect in any type of healthcare. However, there are small changes that the Kugluktuk community can introduce to begin the transformation of their healthcare system.
Access to health information and opportunities for decision-making can be improved. According to a 2011 study by Ekman et al., this can be done by first initiating a narrative. Patients should be given the necessary materials such as websites and pamphlets that inform them about their condition. They should also be encouraged to learn about their health conditions on their own so that when physicians ask them what they want to do, they have a personally meaningful answer. When decisions need to be made about their treatment, patients will feel they have ownership over its design. A shared decision-making process builds the partnership between the health provider and the patient, which promotes continuity of care.
To prepare for cases where patients need to travel to the nearest regional centre to seek urgent physician attention, the community can train health personnel, volunteers or family members to be person-centered escorts tasked to make the patient’s journey safe and bearable. Kugluktuk can follow the practice of the Tuttarvingat community where they provide patients and their escorts with a manual that contains complete information about what to expect, travel preparation requirements and medical boarding homes. However, it is important to begin reducing the community’s dependence on outside physicians by encouraging young people to pursue professions in healthcare.
Another way to introduce person-centered principles in Kugluktuk, therefore, is to provide local care as much as possible. Health providers can be local volunteers who have undergone medical training. Not only will this improve access to health providers, but it will also make communication easier for patients. The community can also put up a platform where patients can air out their grievances. This platform can also serve as a voice for local health policy change. This means that a person-centered healthcare will not only change the role of patients, physicians and family members, but of the entire community as well.
Ekman, I. et al. (2011). Person-centred care – Ready for prime time. Journal of Cardiovascular Nursing. doi:10.1016/j.ejcnurse.2011.06.008