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Clinical Professor/Director of Pharmacy Education
Department of Clinical Pharmacy and Outcomes Science
University of South Carolina School of Medicine Greenville
Greenville, South Carolina
Jennifer N. Clements, PharmD, FCCP, FADCES, BCPS, CDCES, BCACP, BC-ADM: consultant/advisor/speaker: Novo Nordisk, Sanofi.
Collaboration in Person-Centered Care
The definition of collaboration is “to work jointly with others or together, especially in an intellectual endeavor.” Reflecting on this definition is essential when discussing person‑centered care, which can be applied to weight management.
Person-centered care consists of elements related to the understanding of an individual's preferences, as well as showing empathy and using shared decision‑making. In addition, it is important to use active listening and motivational interviewing when determining person-specific goals.
Guideline Recommendations for Collaboration and Person-Centered Care
With collaboration and person‑centered care in mind, it is helpful to consider organizational recommendations on collaboration for weight management. In the most recent Standards of Medical Care–2022, the American Diabetes Association shares evidence‑based recommendations on weight management. It provides a Level E recommendation to use person-centered, nonjudgmental language to foster collaboration between healthcare professionals (HCPs) and patients, including people‑first language. An example of this is to identify someone as a person living with obesity vs an obese person.
Other guidelines are lacking in recommendations in collaboration and person-centered care. The Obesity Medicine Association only mentioned collaboration when providing guidance on motivational interviewing. The American Association of Clinical Endocrinology published comprehensive clinical practice guidelines in 2016 on medical care for those living with obesity, but there are no recommendations or language in this clinical practice guideline on collaboration or person‑centered care.
There is guidance in a collaborative publication from 24 work-group organizations in June 2017, titled Provider Competencies for the Prevention and Management of Obesity. If we take away “provider,” these are competencies that we all can use as HCPs when focusing on a person‑centered approach for weight management, and all of these are applicable to clinical practice.
Let’s consider each of these recommendations and how they can be used for all HCPs in collaborating with people on weight management:
We know that the social determinants of health are related to education access and quality, healthcare access and quality, neighborhood and the environment, social and community context, as well as economic stability. All of these may play a role in why an individual may be living with obesity, and they should be addressed by providing person-centered strategies related to weight management.
Strategies should be used to minimize bias toward this patient population. In addition to using person‑centered language, other strategies should be considered to minimize bias and include promoting policy and advocacy work for this patient population. We also need to think about community‑based strategies that can assist these patients, especially in underrepresented or underserved areas.
One relatively easy way to minimize bias is to be consistent in our clinical approach in practice when working with persons with obesity. An example of this approach is to incorporate the 5 “A’s” into clinical assessment that have been recommended by Obesity Canada:
Finally, evidence‑based practices should be provided to people with obesity‑related conditions. As pharmacists, we have a consistent way to follow best practices that can address weight as well as chronic disease states. This process, known as the Pharmacist–Patient Care Process, attempts to standardize the way we collect subjective and objective information; assess the condition; and, if the patient is meeting therapeutic goals, develop a person‑centered plan, implement the plan, and follow up with monitoring and evaluating.
This process can be applied by other HCPs, but depending on your discipline, you may have a consistent approach that can be used to address an individual’s weight as well as their chronic conditions that would work well in your practice.
In conclusion, obesity is a complicated and multifactorial disease with multiple associated comorbidities. It is essential to collaborate with patients and other HCPs to achieve goals in weight management. We should be using a person-centered approach and person-centered language to build trust with persons living with obesity. And finally, implementing a structured approach for the assessment and treatment of persons living with obesity can improve care and minimize bias.