The requirement to respect autonomy - The Royal New Zealand ...

ORIGINAL SCIENTIFIC PAPErSThe Partners in Health (PIH) self-ratings byboth groups showed positive ratings of self-managementskill and capacity on all domains (withone exception, measuring symptom progress).Questions are raised about the care taken by participantsin noticing that the PIH scale operatesin the opposite direction from other scales usedin this study, i.e. from positive responses (a lot,always or very well) scoring low scores to negaquantitativeresearchPatient Assessment of ChronicIllness Care (PACIC)The PACIC scale includes 20 items and assesseson a five-point scale (1=none of the time, 2=alittle of the time, 3=some of the time, 4=most ofthe time, 5=all of the time) the extent to whichpatients report receiving care that accords with achronic care model of care, including care that ispatient-centred, proactive, planned and includescollaborative goal setting, problem solving andfollow-up support. 2 A higher score at follow-upindicates perceived improvement. The 20 itemscombine to five sub-scales which relate to differentaspects of providing care congruent withchronic care management: patient activation oractions that solicit patient input and involvementin decision-making; delivery system design oractions that organise care and provide informationto patients to enhance their understandingof care; goal setting or the patient acquiringinformation for and setting of specific collaborativegoals; and follow-up or coordination of carewhere clinic treatment is extended and reinforcedand proactive contact with patients to assessprogress and coordinate care. 12 There was a statisticallysignificant improvement (paired samplest-test) at six months from baseline in goal setting(p=0.000), problem solving (p=0.009) and followup(p=0.001) for the intervention group (Table 4).Self- efficacyThe self-efficacy scale enables individuals to ratetheir confidence on a 10-point scale (not at allconfident through to totally confident) on keepingtheir physical discomfort or pain, symptomsand emotional distress from interfering withthings they want to do; different tasks and activitiesmanaged in order to reduce the need to seea doctor; and confidence in doing things otherthan just taking medication to reduce the effectof illness on their everyday life. A higher score atfollow-up indicates improved confidence. For theintervention group there was deterioration in thelevel of self-reported confidence on all scales, althoughthese scores were not significant (Table 5).For the control group there was improvement onseveral of the scales from baseline to six months,with improved confidence with managing emotionaldiscomfort and other symptoms statisticallysignificant (p=0.01 and p=0.042) (Table 5).DiscussionPrimary outcome measuresThis study was designed to test the feasibility ofundertaking a substantive trial and to determineuseful outcome measures for such a trial.Despite the small sample size, some findings areof interest and value in determining directionfor future studies.Figure 1. PACIC sub-scales 12 —goal setting; problem solving; follow-upThe goal setting sub-scale includes the items:‘Over the past six months when I received care for my chronic condition I was:• Asked to talk about my goals in caring for my condition• Helped to set specific goals to improve my eating and exercise• Given a copy of my treatment plan• Encouraged to go to a specific group or class to help me cope with my chronic illness• Asked questions either directly or on a survey about my health habits.’The problem solving sub-scale includes the items :‘Over the past six months when I received care for my chronic condition I was:• Sure that the doctor or nurse thought about my values, beliefsand traditions when they recommended treatments to me• Helped to make a treatment plan that I could carry out in my daily life• Helped to plan ahead so I could take care of my illness even in hard times• Asked how my chronic illness affects my life.’The follow-up sub-scale includes the items :‘Over the past six months when I received care for my chronic condition I was:• Contacted after a visit to see how things were going• Encouraged to attend programmes in the community that could help me• Referred to a dietitian, health educator or counsellor• Told how my visits with other types of doctors like an eye doctor or surgeonhelped my treatment• Asked how my visits with other types of doctors were going.’VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE 299