A patient centred model of health in oncologic care.
The intellectual investigation of health care practitioner in the narrative on their patients is supportive of health equality, inclusion, and transformation of current clinical practices with limited health outcomes. The shift from a patriarchal model of doctor-patient relationship into a collaborative and empowering engagement of everyone into their own health management is much needed. This shift requires reflexivity from the health care practitioner because it challenges self-perpetuating practices and policies. Where to start? I believe that everything starts by reflecting upon the narrative of each patient. Health care practitioners are key in listening to and integrating those narratives into a holistic understanding of each patient within their social and cultural context. For those health care practitioners who have chosen to work within a holistic/integrative model of care, personalized attention is paramount to a greater outcome. As a health care practitioner focused on the management of chronic symptoms secondary to oncologic treatments, my role has gradually transitioned towards one of mediator in response to the limited skills demonstrated by adult cancer survivors. The transition was motivated by the consistent inequality, victimization and disempowerment still experienced by many patients especially from ethnic and Aboriginal/Torres Strait Island communities. Those are people who have undergone oncologic treatments but are still suffering with physical and mental issues in the management of chronic symptoms secondary to oncologic treatments (i.e. xerostomia; lymphoedema; depression, peripheral neuropathies). At all times, these patients feel invisible. This phenomenon persists regardless of informative material made available by health care services. Upon listening to the patients' personal stories of isolation and 'silent pain', I realized that the major obstacle in the recovery and rehabilitation of cancer survivors was not solely related to physical and/or emotional/psychological impediments. It was related to the communication skills of health professionals and to the context within which health discussion or health actions take place. Reflecting upon the need to improve health outcomes in clinical practice, I chose to embrace a concept that considers each person within multiple layers of the physical, social and political systems. I was inspired by the initiative proposed by the Brofenbrenner's Social Ecological Model, an initiative created to increasingly influence the design of wholistic public health program. The model offers great insights about the importance of placing health literacy within contextual issues (Ishikawa & Yano 2008). Nutbeam (2008) encourages health care practices and practitioners to consider a wide array of variables including sender and receiver for their patients. McKenna, Sixsmith & Barry (2017) further encourage the evaluation of participant groups, socio-political environments and levels of participation in communication processes in daily clinical practice. This new theoretical framework predicts that attributes of each person, such as attitude and beliefs, are related to the uptake of a new practice or idea throughout the community. Thinking between microcosm (my clinic) and macrocosm (globally), recent data confirm that over 75% of adults are unable to interpret simple instructions of printed health care material. However, the problem is not about the necessary skills of reading and writing. After all, health care material is written at a third grader level. Instead, I found that the ability to access, retrieve and use health information is closely dependent upon the willingness of individuals to be engaged in their own health care management. Thus, social and environmental factors could be critical determinants of health outcome. I absolutely agree with the theory proposed by Nutbeam (2008) that consider an ecological theory of health and health behaviour focusing on the environment as pivotal for meaningful changes in health behaviour. Hence, my approach to my patients starts by a narrative appraisal of their level of health literacy reflective of empowered decision-making process as well as the ability to recognize and use collective beliefs, customs, worldview and social identity in order to interpret and act on health information.
Ishikawa, H., & Yano, E. (2008). Patient health literacy and participation in the healthcare process. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 11(2), 113122. http://doi.org/10.1111/j.1369-7625.2008.00497.x
McKenna, V. B., Sixsmith, J., & Barry, M. M. (2017). The relevance of context in understanding health literacy skills: Findings from a qualitative study. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 20(5), 10491060. http://doi.org/10.1111/hex.12547
Nutbeam D. (2008) The evolving concept of health literacy. Journal of Social Science Medicine; 67:20722078. doi: 10.1016/j.socscimed.2008.09.050.