Patient and family centred care in respiratory therapy: A fundamental right?

Registered respiratory therapists (RRTs) have long understood that the concept of patient and family centred care is an important element of respiratory therapy practice. RRTs understand the distress of the patient and their family during their interactions with the health care system, and strive to improve how patients experience respiratory care. As a result, quality of care and safety is woven into the approach of every RRT/patient encounter, and ensures that their goals are aligned with the needs of the patient and their family. For many years, there has been substantial consultation with stakeholders on how to define patient and family centred care. Building on the consultation dialogue, the College and Association of Respiratory Therapists (CARTA) and the Canadian Society of Respiratory Therapists (CSRT) embarked in January of 2015 on a collaborative initiative to build on the dialogue and create a consensus statement that is specific to RRTs. The hundreds of RRT stakeholders involved were generous in sharing their experiences and suggestions about how all of us in the respiratory therapy profession may collaborate toward improving patient and family centred respiratory care as the central core and focus of our practice. Placing patients at the forefront of care requires a respect for core concepts including: dignity and respect in care; physical care and comfort; emotional support and responsiveness according to individual patient and family preferences, needs, values and beliefs; utilizing patient values to guide clinical decisions; encouraging patient participation in decision making; and, most importantly, cooperation among care providers to provide a seamless experience for the patient and their family. There have been numerous research initiatives that provide clear evidence that, when the perspective of the patient and their family are included directly in the planning, delivery and evaluation of health care, the quality and safety of health care improves, costs of care are reduced, and provider and patient satisfaction increases. Despite the mountain of evidence that a patient and family centred approach to care results in clear benefits, this is not implemented consistently across the health care system. Despite the numerous initiatives implemented throughout the country, patients and their family often encounter a provider-centric system that is hierarchical based on the medical expert model, in which the medical expert tells other providers and patients what to do and all are expected to comply. There is no question that there has been some progress over the past 10 years, where we now encounter medical experts who value the collaboration of other providers and the patient in the development and execution of the care plan. The health care system frequently appears to be at a crossroads with the integration of patient and family centred care. Given the complexities of the Canadian health care system, it will take the greatest minds in government and the integral collaboration of all levels of the health care system to implement meaningful change – not an easy feat! For RRTs to effectively implement the patient and family centred approach, there must be a shift in practice from the traditional hierarchical relationship toward a focus on creating an equal partnership among all health care providers involved with the patient and their family. We have started experiencing this shift in practice patterns with the integration of the RRT in family health teams and collaborative care models. It is the integration of the patient and their family as an equal partner in health care delivery that is the essential element of an effective patient and family centred care model. What the respiratory therapy profession must continue to achieve is a collaborative respiratory care environment in which the RRT is seamlessly included in the health care team, where the patient and family are always informed participants actively included in a collaborative decision-making process. Given the passion RRTs have for their patients, patient and family centred care is a concept that resonates strongly with the profession. There is no doubt that the respiratory therapy profession is ready to move away from the concept of providing care to/for patients and collaborating with the patient within a collaborative health care team. To learn more about the key elements of patient and family-centred respiratory care, please consult the CARTA/CSRT Consensus Statement (www.carta.ca) (www.csrt.com).