A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness.

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

Assessment of the Quality of Life in Parents of Children With ADHD: Validation of the Multicultural Quality of Life Index in Norwegian Pediatric Mental Health Settings.

Background: The brief generic Multicultural Quality of Life Index (MQLI) is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life (QoL). QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder (ADHD) in children might negatively influence the parents' QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD. Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services (CAMHS) in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index (WHO-5), and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5. Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach's alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high (r = 0.84), reflecting convergent validity since the association between the two measures was strong. Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS.

Person-centred integrative diagnosis: conceptual bases and structural model.

OBJECTIVES: To review the conceptual bases of Person-centred Integrative Diagnosis (PID) as a component and contributor to person-centred psychiatry and medicine and to outline its design and development. METHOD: An analysis was conducted of the historical roots of person-centred psychiatry and medicine, tracing them back to ancient Eastern and Western civilizations, to the vicissitudes of modern medicine, to recent clinical and conceptual developments, and to emerging efforts to reprioritize medicine from disease to patient to person in collaboration with the World Medical Association, the World Health Organization, the World Organization of Family Doctors, the World Federation for Mental Health, and numerous other global health entities, and with the coordinating support of the International Network for Person-centered Medicine. RESULTS: One of the prominent endeavours within the broad paradigmatic health development outlined above is the design of PID. This diagnostic model articulates science and humanism to obtain a diagnosis of the person (of the totality of the person's health, both ill and positive aspects), by the person (with clinicians extending themselves as full human beings), for the person (assisting the fulfillment of the person's health aspirations and life project), and with the person (in respectful and empowering relationship with the person who consults). This broader and deeper notion of diagnosis goes beyond the more restricted concepts of nosological and differential diagnoses. The proposed PID model is defined by 3 keys: broad informational domains, covering both ill health and positive health along 3 levels: health status, experience of health, and contributors to health; pluralistic descriptive procedures (categories, dimensions and narratives); and evaluative partnerships among clinicians, patients, and families. An unfolding research program is focused on the construction of a practical guide and its evaluation, followed by efforts to facilitate clinical implementation and training. CONCLUSIONS: PID is aimed at appraising overall health through pluralistic descriptions and evaluative partnerships, and leading through a research program to more effective, integrative, and person-centred health care.

Measuring cultural identity: validation of a modified Cortes, Rogler and Malgady Bicultural Scale in three ethnic groups in New York.

Cultural identity is central to health. Acculturation may be formulated with a bicultural model, assessing in parallel the degree of identification with both the original and the host culture. The Cortes, Rogler and Malgady Bicultural Scale (CRM-BS) is composed of two subscales: "original" culture and "mainstream-United States" (US) culture. It was modified into three ethnic versions: Latino, Korean and Chinese. Validation of the CRM-BS was conducted using health professionals and psychiatric patients from the above three ethnic groups and a control sample of mainstream-US (main-US) health professionals in New York City (n = 394). Mean time of completion was 3.7 min and 73% judged it to be easy to use. Strong test-retest reliability correlation coefficients were found (original culture, 0.78; mainstream-US, 0.82). The internal consistency was documented by high Cronbach's alpha values (original culture, 0.88; mainstream-US, 0.80). Factorial analysis revealed two factors, the first one involving all the items of the original culture and the second all of the mainstream-US items. Concerning its discriminant validity, non-main-US subjects scored significantly higher than main-US subjects on the original culture subscale, and vice versa. Construct validity was assessed comparing intergenerational mean scores on both subscales; as generations become older, mean scores for the original culture decreased, while those for the "host" culture increased. Results for each specific ethnic version are also presented. Cutoff scores were calculated to categorize the involvement with the original culture or the host culture, both of them, or neither.

Cultural formulation guidelines.

The outline for the Cultural Formulation (CF) introduced in DSM-IV does not present any method for collecting the required cultural information. The absence of specific guidelines and illustrative cases has hampered its wider use. This article offers a practical approach to preparing a Cultural Formulation as a component of culturally competent clinical care. We summarize the rationale for the four sections of the CF, describe the process of conducting culturally focused clinical interviews, and present examples of questions or lines of inquiry that can be used to collect the information needed to construct the CF. An online supplement provides case examples of cultural formulations applied to patients seen in the US.

The portuguese version of the personal health scale: a validation study in southern Brazil.

UNLABELLED: The Personal Health Scale is a concise instrument for comprehensive culture-informed and self-rated assessment of general health status and well-being. It is composed of 10 questions that appraise different health dimensions collated from the international literature, including aspects ranging from somatic and psychological domains to social functioning and insight. PURPOSE: In this investigation, results of a study conducted in Southern Brazil to test and validate the Portuguese version of the Personal Health Scale (PHS-Pt) are presented. METHOD: This study analyzes data from a sample of 120 Brazilian volunteers (90 patients and 30 health care professionals). All patients completed the Portuguese version of the Personal Health Scale under a minimal guidance by trained examiners, who followed standardized instructional procedures. RESULTS: The internal consistency of the PHS-Pt attained a Cronbach's a of 0.75 among patients and of 0.69 among health care professionals. The test-retest reliability correlation coefficient yielded a score of 0.82. Furthermore, the PHS-Pt was able to detect a significant discriminating validity between the 2 evaluated samples (P < .001). CONCLUSIONS: The original English version of the Personal Health Scale was successfully adapted to Portuguese as methodologically demonstrated herein. The PHS-Pt constitutes a reliable and trustworthy research instrument for evaluating health status in Brazil, since it is appropriately designed to distinguish different groups of volunteers regarding their health status.

Validation study of the Multicultural Quality of Life Index (MQLI) in a Peruvian sample.

OBJECTIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (with presumed higher quality of life, n = 50). Data on its applicability and internal structure were compiled from the 130 subjects. RESULTS: A high reliability correlation coefficient (r = 0.94) was found for the total score. The discriminant validity study found a significant difference between mean total score in the samples of presumed higher (7.66) and lower (5.32) quality of life. The average time to complete the Multicultural Quality of Life Index was less than 4 minutes and was reported by the majority of subjects as easily applicable. A high Cronbach's a (0.88) was also documented. CONCLUSIONS: The results reported that the Multicultural Quality of Life Index is reliable, has a high internal consistency, is capable of discriminating groups of presumed different quality of life levels, is quite efficient, and easy to use.

[Person centered clinical care: principles and strategies]. / Atención clínica centrada en la persona: principios y estrategias.

The development of person-centered clinical care is inscribed within an international programmatic movement towards a medicine focused on the totality of the person. This movement, with broad historical bases, has been maturing since 2008 through conferences among global health institutions, research projects and academic publications. This paper is aimed at elucidating the conceptual principles of person-centered medicine (PCM) and to delineate strategies for the practical application of such principles in clinical care services. The above objectives have been approached through literature reviews, international consultations, and reflections on the patterns and indications obtained. The principles identified for person-centered medicine are the following: Ethical commitment, holistic framework, cultural awareness and responsiveness, communication and relational focus, individualized clinical care, common ground among clinicians, patient and family for joint diagnostic understanding and shared decision making, person- and community-centered organization of integrated services, and person-centered medical education and research. Additionally, pertinent strategies have been delineated for the implementation of such principles in clinical care. The authors conclude that the presented principles and strategies are consistent with suggestions offered in the literature and may serve as bases for the design of indices and scales. Their continuous refinement is proposed through future international and local studies. to clarify the key concepts of the movement as well as strategies for their practical clinical application.

From financial analysis to policy development in mental health care: the need for broader conceptual models and partnerships.

International mental health economics is emerging as a significant field in the increasingly intricate and interactive world in which we live. In line with this, the conceptualisation and gathering of pertinent data for international studies such as WHO's Atlas Project pose considerable methodological challenges. This paper outlines the need for broader conceptual models and partnerships and discusses some promising endeavours.

A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All.

Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine's 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one's life in ways that are personally meaningful and that are respectful of others and the environment in which we live together. Evidence suggests that health care organizations function well when they operate in a person-and people-centered way because that stimulates better coordination, cooperation, and social trust. Health care coverage must be integrated at several interconnected levels in order to be effective, efficient, and fair. To reduce the burden of disease, integration is needed between the people seeking and delivering care, within the social network of each person, across the trajectory of each person's life, among primary caregivers and specialists, and across multiple sectors of society. For integration to succeed across all these levels, it must foster common values and a shared vision of the future.

Background, Structure and Priorities of the 2013 Geneva Declaration on Person-centered Health Research.

Declarations are relevant tools to frame new areas in health care, to raise awareness and to facilitate knowledge-to-action. The International College on Person Centered Medicine (ICPCM) is seeking to extend the impact of the ICPCM Conference Series by producing a declaration on every main topic. The aim of this paper is to describe the development of the 2013 Geneva Declaration on Person-centered Health Research and to provide additional information on the research priority areas identified during this iterative process. There is a need for more PCM research and for the incorporation of the PCM approach into general health research. Main areas of research focus include: Conceptual, terminological, and ontological issues; research to enhance the empirical evidence of PCM main components such as PCM informed clinical communication; PCM-based diagnostic models; person-centered care and interventions; and people-centered care, research on training and curriculum development. Dissemination and implementation of PCM knowledge-base is integral to Person-centered Health Research and shall engage currently available scientific and translational dissemination tools such journals, events and eHealth.

The dynamic origins of positive health and wellbeing.

The causes of wellbeing and illbeing interact with feedback dynamics resulting in the same set of traits giving rise to a variety of health outcomes (multi-finality) and different traits giving rise to the same health outcome (equi-finality). As a result, a full understanding of health and its disorders must be in terms of a complex adaptive system of causes, rather than in terms of categorical diagnoses or sets of symptoms. The three domains of person-centered integrative diagnosis (PID) are considered here as interacting components of a complex adaptive system comprised of health status (functioning/wellness versus disability/disorder), experience of health (self-awareness/fulfillment versus misunderstanding/suffering) and contributors to health (protective versus risk factors). The PID domains thereby allow healthcare and health promotion to be understood in terms of measurable components of a complex adaptive system. Three major concepts of health are examined in detail to identify their dynamic origins: Psychological Maturity, Flourishing and Resilience. In humanistic psychology, psychological maturity (i.e. healthy personality, mental wellbeing) involves the development of high self-directedness, high co-operativeness and high self-transcendence, but self-transcendence is nevertheless devalued in individualistic and materialistic cultures except when people must face adversity and ultimate situations like suffering or the threat of death. Psychological Maturity develops through two complementary processes often labeled as Flourishing and Resilience. Flourishing is the development of one's potential to live optimally, especially as the result of favorable circumstances, whereas Resilience is positive adaptation to life despite adverse circumstances. As a result of the complex feedback dynamics between the processes of flourishing and resilience, each person is a unique individual who has a variety of paths for achieving positive health and wellbeing open to him or her. Person-centered health promotion and care can thereby be approached as a creative life project that can be conducted with the assistance of healthcare workers who are both therapeutic allies and well-informed experts.

The Geneva Conferences and the emergence of the International Network for Person-centered Medicine.

The yearly Geneva Conferences on Person-centered Medicine started in May 2008 as a collaborative effort of global medical and health organizations and committed clinicians and scholars to place the whole person at the centre of medicine and health care. They were informed by the traditions of great ancient civilizations and recent developments in clinical care and public health. The process of the Geneva Conferences led to the development of the International Network for Person-centered Medicine as a non-for-profit institution aimed at organizing future editions of the Geneva Conference and building person-centred medicine as a paradigmatic repriorizing of the medical and health fields in collaboration inter alia with the World Medical Association, the World Health Organization and the World Organization of Family Doctors.

Atención clínica centrada en la persona: principios y estrategias / Person centered clinical care: principles and strategies

RESUMEN El desarrollo de una atención clínica centrada en la persona se inscribe dentro de un movimiento programático internacional hacia una medicina centrada en la totalidad de la persona. Este movimiento, con amplias bases históricas, ha ido madurando desde 2008 a través de encuentros entre instituciones globales de salud, proyectos investigativos y publicaciones académicas. El presente artículo se propone elucidar los principios conceptuales de la medicina centrada en la persona (MCP) y delinear estrategias para su aplicación práctica en servicios de atención clínica. La consecución de los mencionados objetivos se ha basado en revisiones de la literatura, consultas internacionales y reflexión sobre índices y pautas obtenidos. Los principios identificados de MCP son los siguientes: compromiso ético, marco holístico, sensibilidad cultural, foco comunicativo y relacional, individualización de la atención clínica, base común entre clínicos, paciente y familia para el entendimiento diagnóstico y la acción terapéutica, organización de servicios integrados y centrados en las personas, y educación médica e investigación en salud centradas en la persona. Adicionalmente, en relación con cada principio, se delinean estrategias propicias para su implementación en la atención clínica. Se concluye que los principios y estrategias presentados son consistentes con sugerencias ofrecidas en la literatura y que pueden servir de base para el diseño de índices y escalas. Se propone su continuo refinamiento a través de futuros estudios internacionales y locales para clarificar los conceptos claves del movimiento y estrategias útiles en aplicaciones clínicas prácticas.

ABSTRACT The development of person-centered clinical care is inscribed within an international programmatic movement towards a medicine focused on the totality of the person. This movement, with broad historical bases, has been maturing since 2008 through conferences among global health institutions, research projects and academic publications. This paper is aimed at elucidating the conceptual principles of person-centered medicine (PCM) and to delineate strategies for the practical application of such principles in clinical care services. The above objectives have been approached through literature reviews, international consultations, and reflections on the patterns and indications obtained. The principles identified for person-centered medicine are the following: Ethical commitment, holistic framework, cultural awareness and responsiveness, communication and relational focus, individualized clinical care, common ground among clinicians, patient and family for joint diagnostic understanding and shared decision making, person- and community-centered organization of integrated services, and person-centered medical education and research. Additionally, pertinent strategies have been delineated for the implementation of such principles in clinical care. The authors conclude that the presented principles and strategies are consistent with suggestions offered in the literature and may serve as bases for the design of indices and scales. Their continuous refinement is proposed through future international and local studies. to clarify the key concepts of the movement as well as strategies for their practical clinical application.

Outlining the bases of person-centred integrative diagnosis.

UNLABELLED: RATIONAL AND AIMS: As diagnosis is a critical first step for clinical care, it was early recognized that an appropriate diagnostic model was necessary as informational basis for person-centred clinical care. METHODS: The design of a person-centred integrative diagnosis model was based on literature reviews and work meetings in London, Paris, Geneva, Preston, UK and Uppsala, Sweden over the past 2 years. RESULTS AND CONCLUSION: The current person-centred integrative diagnosis model argues for a broader concept of diagnosis and covers both ill health and positive health through the following three levels: Health Status (from illness to recovery/wellness and from disabilities to adaptive functioning), Experience of Health (cultural factors and values concerning ill health and positive health) and Contributory Factors (including internal and external risk and protective factors). Each of these domains will be evaluated with standardized categories and dimensions as well as narratives. Specific attention is paid to evaluators (clinicians, patient, family and other carers) and the interactive evaluation process.

Developing an Institutional Informational Base and Bibliographical Clearinghouse.

Successful management and implementation of the diverse functions of the International Network of Person-Centered Medicine (INPCM) require a comprehensive and efficient informational base to advance quality of patient care though timely and rapid distribution of knowledge via publications, conferences, and education programs in concert with catalyzing research through systematic efficient data acquisition, storage, retrieval, and analysis. This study describes the structure and functions of the proposed INPCM's information system.