Patient-Centered Interventions: A Custom Fit

Professors Sandra Ward (middle) and Karin Kirchhoff (second from left) receive a CPCI project update from center staff Julia Greenleaf (far left), Anita Rawls, and Tom Godfrey.

A one-size-fits-all approach is just as sure to cause frustration in your health care as it is in your local mall.

“What if you walked into a department store, and there was just one suit size?” asks UW-Madison School of Nursing Professor Karin Kirchhoff, PhD. “The expectation would be that everyone is supposed to fit into that size, while in reality, most of us come in different sizes. There always needs to be a bit of customized tailoring so that it fits an individual better.” And just like that suit, nursing care should be customized to fit an individual patient. It should be patient centered.

The National Institute of Nursing Research has recently awarded two grants totaling $2.8 million to University of Wisconsin- Madison School of Nursing to develop patient-centered, customized strategies. Primary investigator Sandra Ward, PhD, Helen Denne Schulte Professor of Nursing, will lead a team of researchers at the newly created Center for Patient- Centered Interventions (CPCI) on the UW-Madison campus. One of the grants provides funding for faculty projects; the other supports pre and postdoctoral study.

“The exploratory center to be established here is a wonderful step forward in the research enterprise,” states Katharyn May, dean of the School of Nursing. “This award acknowledges the expertise of our colleagues in patient-centered intervention research and, literally, puts the school on the map in a new way in terms of National Institutes of Health funding.”

While patient-centered care is often a buzz phrase today, Ward is quick to point out that these grants really support the testing of patient-centered interventions.“Care, “says Ward, “is everything a nurse does and is made up of individual interventions. A physiological intervention might be rebandaging a wound. The kind of interventions we’re testing here are more psychosocial and educational, such as talking to a patient about a healthier diet.”

The three pilot investigators are Susan Heidrich, PhD, who will be studying symptom management in elderly women; Kristine Kwekkeboom, PhD, who will research non-drug pain management strategies; and Diane Lauver, PhD, who will study health promotion interventions, such as those dealing with diet and exercise. Kirchhoff, the project’s co-director, is working on end-of-life decision making and withdrawal-of-life-support issues, while Ward is working on pain management interventions.

There is a long history of research behind patient care, but most of it has been a one-size-fits-all. “There have been many outstanding one-size-fits-all studies,” explains Ward, “such as Professor Emerita Jean Johnson’s wonderful series of studies about how to help people cope with stressful medical procedures. It’s just that we’re trying to move beyond that.”

Research by Johnson involved giving patients accurate sensory information by tape recording herself talking about what people would see, feel, and hear during a particular medical procedure. For instance, patients who were about to have casts removed via cast cutters heard a taped message about what to expect from the procedure. “This type of intervention was better than prior preparation techniques,” says Ward, “but it’s not patient centered. In a patient-centered intervention, the messages get individualized for everyone in the study.”

Kirchhoff offers an example of individualized, patient-centered interventions from her own research on end-of-life decision making. She works to prepare families for withdrawal of ventilatory support. First, she makes a clinical determination of how long the patient is expected to live following withdrawal, based on variables identified in the research. “I do that on the basis of whether the patient is dependent on blood pressure medication and a ventilator,” Kirchhoff notes. “If that patient is dependent, he or she is going to have a very short time until death. If not, that person is probably going to live longer.”

Based on this analysis, Kirchhoff gives different information to the family. If there is a very short time until death, she doesn’t talk about color and temperature changes. If the clinician doing the withdrawal of ventilator support is going to pull the tube first, she prepares the family for noisy breathing. “So some of the information I provide is the same for everyone,” she says, “such as what the family is able to do at the bedside. But I tailor what the family will see, feel, and hear based on clinician or patient variables.”

Although receiving either of the two grants would have been a major step forward in nursing care research, Ward is particularly pleased that the new Center for Patient-Centered Interventions has the support of both grants. “The news story about the receipt of these two grants is really the story about a lot of people working together to make nursing care better for all,” says Ward. Better for all, that is, one individualized intervention at a time.

For more information, visit the Center for Patient-Centered Interventions home page.