Patient-centred care is about meaningful partnership between the patient and provider. It takes into account the unique needs and preferences of each patient, and aims to and empower patients as experts in their own care.19 Patient-centred care encompasses a variety of approaches that attempt to account for power imbalances and experiences of marginalization.
Research suggests that incorporating patient-centred approaches into the clinical management of substance use disorders can improve retention in care, treatment satisfaction, and health outcomes.20-22 Practical strategies for incorporating patient-centred care in the clinical management of OUD include19:
- Collaboratively developing treatment plans
- Encouraging patients to set treatment goals that are meaningful to them (rather than imposing goals on them)
- Using a shared decision-making framework to select treatment options or interventions
- Being open to and respectful of patient agency and choice
Clinicians, care teams, and staff should be aware of and actively work to reduce the stigma experienced by individuals with OUD, including awareness of the language they use in clinical encounters and its potential to stigmatize individuals who use opioids and other substances. Clinicians and staff involved in substance use care should strive at all times to use “person-first” language and current medical terminology (e.g., person with an opioid use disorder) when interacting with patients, families, colleagues, health care professionals, and staff.23
While patients may choose to refer to themselves and their health conditions using language that they are most comfortable with, clinicians, other health care professionals, and non-clinical staff should avoid using non-diagnostic, outdated, or “slang” terms (e.g., “junkie”, “addict”, “opioid abuse”, “clean/dirty”) in conversation and when charting. Use of such terms by health care providers has been shown to be stigmatizing to some patients24,25 and to influence the behaviors of subsequent clinicians when included in a medical record.26 Stigma—both experienced and anticipated—has been associated with a reduced likelihood of accessing and staying in care27-29 as well as receiving worse care.26 Clinicians are encouraged to review Respectful Language And Stigma: Regarding People Who Use Substances, a resource jointly developed by the BC Centre for Disease Control, the Provincial Health Services Authority, and Toward the Heart, for more information.
2.1.i Reducing Barriers and Increasing Flexibility
Patient-centred care includes providing access to services and treatments without undue barriers. Commonly reported barriers to OUD treatment include lack of control or flexibility with treatment and difficulty with access.30 Care teams should strive to assess a patient’s needs and ability to access treatment and facilitate low-barrier options. Furthermore, events over recent years, including the COVID-19 pandemic and climate emergency-related phenomena (e.g., wildfire evacuations, weather warnings due to extreme heat, flooding), have demonstrated the necessity and feasibility of clinical flexibility that prioritizes patient safety and continuity of care. Patient-centred care involves adapting, as needed, during local or global emergencies and disruptions, to ensure that patients can continue to access life-saving treatment without putting their health at risk (e.g., waiting in extreme heat) or facing unreasonable barriers. Examples of adaptations may include extended carries; reduced urine drug testing; reduced clinic appointments or shifting toward virtual care; facilitating transfer of prescriptions to a new pharmacy; or engaging other health care providers to support medication management. Prescribers are encouraged to consult the 24/7 Line or RACE app if they need support to adapt care plans in response to states of emergency or other disruptive events. Exceptions to standard clinical care should be documented, including the rationale, patient discussion, and patient consent.