Table 4.
Framework of Patient-Centered Care and Satisfaction in Pediatric Obesity Treatment
| Tenets of Patient-Centered Carea | Definitiona | Satisfaction Dimensions and Features to Address |
|---|---|---|
| Respect for patient's values, preferences, and needs | Opportunity to be involved and informed in medical decision making, guiding, and supporting medical care providers. This can involve attention to quality of life, shared decision making, and customizing care, and process can be dynamic over time | Cultural competency |
| Challenges and barriers experienced in care | ||
| Patient and family inclusion in treatment decisions | ||
| Privacy | ||
| Mutuality of treatment focus between family and clinicians (family guiding treatment process) | ||
| Treatment preferences (individual, group) | ||
| Provider sensitivity to weight of child (language) | ||
| Provider value patient and family concerns | ||
| Coordinated and integrated care | Medical care providers coordinating tests, consultations, procedures, and other services to ensure accurate information reaches those who need it in a timely manner. Managing smooth transitions from one setting and provider to another | Accessibility of clinic and appointment times |
| Coordination with other health-related services, particularly in regards to weight-related co-morbidities | ||
| Transportation to clinic and other treatment programming | ||
| Quality of teamwork in multidisciplinary and interdisciplinary teams | ||
| Cost of treatment | ||
| Attention to missed school and work | ||
| Information, communication, and education | Accurate answers in a language and terms they understand, answering questions of diagnosis, prognosis, and management or treatment. Patients and families desire trustworthy information that is attentive, responsive, and tailored to individual needs | Helpfulness of educational materials and handouts |
| Ability to understand materials | ||
| Ability to clearly understand clinicians | ||
| Provider knowledge of information pertinent to patient and family | ||
| Quality of clinician–patient communications | ||
| Time spent discussing treatment concerns | ||
| Patient and family ability to ask questions | ||
| Comfort with clinicians | ||
| Ability to use alternative means of communication (e-mail, phone) | ||
| Understanding of treatment process | ||
| Physical comfort | Management of symptoms that is timely, tailored, and expert to relieve discomfort | Comfort of facilities (furniture, exercise equipment) |
| Improved comfort of obese children (skin folds, musculoskeletal pain, fit of clothes) | ||
| Emotional support, relieving fear, and anxiety | Attention to anxiety that accompanies illness, which may be from uncertainty, fear of pain, disability or disfigurement, loneliness, financial stress, or impact on family. This should include physical, emotional, and spiritual dimensions | Clinician attention to emotions of obese children: self-esteem, depressive symptoms, peer and family relationships, teasing and bullying |
| Accurate explanation of short and long-term risks of obesity | ||
| Preparation for treatment | ||
| Provider attitudes: courtesy, friendliness, respectfulness, warmth, caring, empathetic, reassuring, trustworthiness | ||
| Involve family and friends | Including family and friends who provide support and care. Family and friends should be more than accommodated, but welcomed and be made comfortable in the medical care setting | Inclusion of family and friends in treatment process |
| Accommodations made for family and friends | ||
| Sensitivity of clinicians to family and friends in treatment process |
a
Adapted from Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press, 17.