New perspectives on person-centered care: an affordance-based account
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SCIENTIFIC CONTRIBUTION
New perspectives on person‑centered care: an affordance‑based account Juan Toro1,2 · Kristian Martiny1,2 Accepted: 27 August 2020 © Springer Nature B.V. 2020
Abstract Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care. Keywords Person-centered care · Cerebral palsy · Theory of affordances · Personalistic attitude · Rehabilitation · Phenomenology
Introduction Over the last 2 decades, there has been a growing interest among healthcare professionals in the person-centered approach. Person-centered care (PCC) can be seen as a further development of the patient-centered approach. The latter was established as a systemic reaction to the more traditional disease-focused, bio-medical model (Anderson and Funnell 2005; Tanenbaum 2015). It was a way to center the ‘whole patient’ in healthcare—not just parts of the patient (e.g. the disease, organ, or system)—and to empower the patient during the process. However, the patient-centered approach failed to counteract the movement of the traditional medical model Juan Toro and Kristian Martiny contributed equally to this work. * Juan Toro [email protected] Kristian Martiny [email protected] 1
Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
The Enactlab, Copenhagen, Denmark
2
and its drive to put more epidemiology into clinical practice (Buetow 2016). PCC is developed out of this failure. In contrast to the patient-centered approach, PCC aims to go beyond the socially defined, functional and professional categories, goals and principles for understanding and working with a patient in a healthcare setting (Buetow et al. 2016). PCC aims to explicitly understand the personhood of the patient in order to value and respect the person when providing the healthcare, as well as to highlight the personhood and welfare of the healthcare professional (Buetow 20
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