6.1. Introduction
For people using healthcare services, to be treated as an individual is an essential component of their whole experience and in retaining their dignity during a stressful period. Each patient experiences healthcare in a unique and individual way. For many, healthcare forms a small, but important part of their wider life. Being recognised and treated as an individual remains important to a person when they become a patient. In many ways the need is strengthened, particularly at a time when a person can feel vulnerable. In accordance with this, there is an important need for health services to recognise that individuals are living with their condition(s), experiencing it in a unique way, and that family and broader life need to be taken into account. Recognising individuals within the health service means understanding and acknowledging their experiences, hopes and expectations. It may mean considering future uncertainty, feelings of loss, guilt or shame and feelings of being morally judged or blamed by health care professionals. Some of these feelings originate ‘outside’ of the health care system but are brought with the patient into it. Other experiences may be affected by attitudes and expectations of health professionals. Recognising and responding to the needs of an individual forms an important underpinning to the concept of personalisation and to the development of a responsive service that is truly patient-centred. Therefore, seeing patients as individuals within a complex health service becomes an important requirement for a good patient experience.
6.2. Evidence reviews and other inputs
Each of the following sources of evidence and information has been used to inform the recommendations on patient as individual and a discussion of this is presented in section Recommendations and link to evidence.
6.2.1. Patient experience scoping study - a focused thematic qualitative overview review
The patient experience scoping study (please see Appendix B for the full report) identified aspects related to knowing the patient as an individual in the three clinical areas examined. The findings are summarised in :
Sub-themes from the patient experience scoping study related to knowing the patient as an individual.
In addition, the framework developed by on the basis of the scoping report also identified Lived Experience as a main theme, and is described as follows:
The recognition that individuals are living with their condition and experiencing it in a unique way, that family and broader life need to be taken into account, and that all of these aspects of lived experience can affect self-care. Taking into account individual physical needs and cognitive needs because of condition. Everyday experiences, hopes, expectations, future uncertainty, feelings of loss, feelings of being morally judged, feelings of blame. Some of these experiences originate ‘outside’ of the health care system but are brought with the patient into the health system; other experiences may be affected by attitudes and expectations of health professionals.
6.2.2. NHS surveys
NHS Surveys are used to assess patient experience, to examine how the NHS performs and to identify which aspects of patient experience are most important to patients. Further information on patient surveys is in Section 5.4.
Leatherman and Sutherland in a Quest for Quality and Improved Performance (QUIPP) report (2007)44 attempt to draw together the evidence of what patients want from the NHS. They concluded that ‘to be treated as an individual’ is an aspect of care that is consistently identified as important.
6.2.3. Existing NICE recommendations
The following recommendations, related to knowing the patient as an individual, are already in existence in other published NICE guidelines (please see Appendix C for more details on existing NICE recommendations):
Consider any factors such as physical or learning disabilities sight or hearing problems and difficulties with reading or speaking English, which may affect the patient’s involvement in the consultation. (From ‘Medicines adherence’, R 1.1.2)
79Be aware that patients’ concerns about medicines, and whether they believe they need them, affect how and whether they take their prescribed medicines. (From ‘Medicines Adherence’, R 1.1.19)
79Address any beliefs and concerns that patients have that can result in reduced adherence. (From ‘Medicines Adherence’, R 1.2.7 )
79Listen to patients and respect their views and beliefs. (From ‘Chronic heart failure’, R1.5.5.2)
55Avoid making assumptions based on a woman’s culture, ethnic origin or religious beliefs. (From ‘Pregnancy and complex social factors’, R 1.3.9)
85Assessment and discussion of patients’ physical, psychological, social, spiritual and financial circumstances should be undertaken at key points. Offer support where appropriate. (From ‘Advanced breast cancer’ R1.4.1)
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6.3. Recommendations and link to evidence
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| Recommendations |
Develop an understanding of the patient as an individual, including how the condition affects the person, and how the person’s circumstances and experiences affect their condition and treatment. Ensure that factors such as physical or learning disabilities, sight, speech or hearing problems and difficulties with reading, understanding or speaking English are addressed so that the patient is able to participate as fully as possible in consultations and care. Ask the patient about and take into account any factors, such as their domestic, social and work situation and their previous experience of healthcare, that may: impact on their health condition and/or affect their ability or willingness to engage with healthcare services and/or affect their ability to manage their own care and make decisions about self-management and lifestyle choices.
Listen to and address any health beliefs, concerns and preferences that the patient has, and be aware that these affect how and whether they engage with treatment. Respect their views and offer support if needed to help them engage effectively with healthcare services and participate in self-management as appropriate. Avoid making assumptions about the patient based on their appearance or other personal characteristics. Take into account the requirements of the Equality Act 2010 and make sure services are equally accessible to, and supportive of, all people using adult NHS services. If appropriate, discuss with the patient their need for psychological, social, spiritual and/or financial support. Offer support and information to the patient and/or direct them to sources of support and information. Review their circumstances and need for support regularly.
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| Relative values of different outcomes | The GDG believed that knowing the patient as an individual was an essential aspect of good patient care. |
| Trade off between clinical benefits and harms | The GDG considered that while the recognition and response to the patient as an individual was a right for each patient, consideration of the patient as an individual also improved safety, efficiency and effectiveness of health care. Recognising the individual needs of each patient for help with communication for example allows patients to benefit from services that are available and accessible in a timely way. The GDG was mindful, however, that unnecessary pressure should not be placed on patients to discuss ay subjects they might be unwilling on unready to do so. |
| Economic considerations | The GDG considered that some of the recommendations may have time, and therefore cost implications; however they were considered an essential part of good patient care. They also considered that there may be cost offsets due to improved safety, efficiency and effectiveness of healthcare. |
| Quality of evidence | The GDG used evidence from the patient experience scoping study and consensus to develop the recommendations. |
| Other considerations | The GDG used their own professional and personal experiences to inform these recommendations.
The GDG recognised that healthcare professionals working in the NHS can be under pressure to deliver care in busy environments. For the individual patient however each interaction with professionals and services is a unique experience and part of a wider life experience. The patient cannot be separated from their wider life experience and services need to recognise patient individuality and their social embeddedness.
The GDG recognised that many healthcare professionals and patients achieve this balanced approach despite working in busy environments and that this was related to attitude and skills of those professionals.
The GDG emphasised the importance of healthcare professionals seeing the patient as equal, and to value their lived experience. The GDG felt it was important for clinicians to establish the patient’s background, such as personal circumstances, social and work situation, health literacy, and previous medical experience.
The GDG believed that clinicians have an important role in helping patients to have realistic expectations of treatment. The first step of this process is to explore a patient’s beliefs and understanding of their treatment and procedures.
The GDG considered that it was essential for healthcare professionals to have a non-judgemental attitude towards the patient. The Equality Act 2010 covers nine protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. The GDG considered that a good patient experience should not be compromised because of any patient’s physical and mental characteristics, for example appearance or dress. The GDG felt it was important for clinicians to be supportive but not patronising, and to describe to patients the pertinent options and tools available to support them. |
