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New perspectives on person-centered care: an affordance-based account

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Abstract

Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.

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Notes

  1. Thanks to one of the reviewers for making clear the difference between the patient- and person-centered approaches. We agree with the reviewer that typically these two approaches are conflated, and that the terms ‘patient’ and ‘person’ are used as synonyms. However, there is a distinguishable difference in working with a patient- and person-centered approaches in health care. Thus, when we use the term ‘patient’ we do so while acknowledging that the term is socially defined within a healthcare setting, but maintaining the strong emphasis on the personhood of the patient.

  2. Mead and Bower operate with five conditions for patient-centered care: (1) biopsychosocial perspective, (2) ‘patient-as-person’ (3) sharing power and responsibility, (4) therapeutic alliance and (5) ‘doctor-as-person’ (Mead and Bower 2000). In our conceptualisation of PCC we group (2) and (5) under the heading of personal and (3) and (4) under the heading of participatory.

  3. Gibson proposed the notion of mutual affordance, and considered it extremely important for an account of perception: “The richest and most elaborate affordances of the environment are provided by other animals and, for us, other people. (…) Sexual behavior, nurturing behavior, fighting behavior, cooperative behavior, economic behavior, political behavior—all depend on the perceiving of what another person or other persons afford, or sometimes on the misperceiving of it” (Gibson 1979, pp. 126–127). Nevertheless, he didn’t develop it further. We hereby propose a phenomenologically inspired notion of mutual affordance.

  4. See also Brancazio (2020) for a detailed account of the different types of affordances.

  5. The theory of affordances was deeply influenced by Husserlian phenomenology through Gibson’s reading of Merleau-Ponty’s Phenomenology of Perception. See Lobo et al. (2018).

  6. We thank Sofie Ejlersen for calling our attention to this point.

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Acknowledgements

We want to thank specially Mikkel D. Justiniano, John Paulin Hansen and Per Bækgaard for their contribution in the technical aspects of the experiment, and gathering of data, as well as for providing the equipment. We would like to thank Dan Zahavi, Marianne Klinke, Sofie Ejlersen, Mie Maar Andersen and Patricia de Lipthay Behrend for their comments on earlier versions of this article. Thanks to the therapists and employees at the Elsass Institute for their participation in both the pilot experiment and in the actual experiment, and for their comments on the presentation we gave based on this article. Thanks to the people at the Enactlab, Jacob Nossell, David Eskelund Nielsen and Asger Juhl for their help in developing and performing the experiment. And thanks to all the people with cerebral palsy, their relatives and the strangers for their participation. Finally, we would like to thank the two anonymous reviewers for their helpful comments, which improved the quality of the argument, and helped us making clear some important conceptual distinctions.

Funding

Juan Toro’s research is supported by Colciencias, grant 756-2016, and Kristian Martiny is supported by funding from the Enactlab and the Elsass Foundation.

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  1. Juan Toro and Kristian Martiny contributed equally to this work.

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  1. Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark

    Juan Toro & Kristian Martiny

  2. The Enactlab, Copenhagen, Denmark

    Juan Toro & Kristian Martiny

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Toro, J., Martiny, K. New perspectives on person-centered care: an affordance-based account. Med Health Care and Philos 23, 631–644 (2020). https://doi.org/10.1007/s11019-020-09977-w

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