Patient empowerment in the United States: a critical commentary

Abstract

Whilst there is no consensus amongst analysts regarding how best to define ‘patient empowerment’, at the very least, this concept entails a re‐distribution of power between patients and physicians. Empowered patients attempt to take charge of their own health and their interactions with health care professionals. Empowerment can occur at different levels (micro, meso, and macro) and patients have different ideas about what it means to ‘take charge’ and ‘be empowered’. Some patients simply want to be given information about their conditions whilst others want to have full control over all medical decision‐making. Some empirical evidence suggests that active patient participation in health care is associated with better patient outcomes. This field is ripe for future studies which both help to develop theoretical models of patient empowerment and articulate the conditions under which patient empowerment occurs.

Perceived control in health care: A conceptual model based on experiences of frail older adults

“…The key notion that perceived control is based on the combination of perceived internal and perceived external influences is supported by other studies that equally described personal and environmental aspects of comparable concepts such as involvement (Bastiaens et al, 2007), empowerment (Roberts, 1999), or resilience (Wiles, Wild, Kerse, & Allen, 2012). Indeed, many of the aspects mentioned in earlier studies were incorporated in our conceptual model, e.g.…”

“…Indeed, some level of involvement was found to be important to many patients, based on data resulting from patient interviews or questionnaires (Bastiaens, Van Royen, Pavlic, Raposo, & Baker, 2007;Frosch & Kaplan, 1999). At the same time, however, there appears to be much variance between and within (older) patients concerning their wish to participate in medical decision-making: not all patients are equally willing to do so (Bastiaens et al, 2007;Brody, 1980;Frosch & Kaplan, 1999;Roberts, 1999). Generally, it was seen that if patients were more involved in their own care, they showed better health behaviours (Hochhalter, Song, Rush, Sklar, & Stevens, 2010) and improvement in control of chronic diseases (Rohrer et al, 2008).…”

“…In the literature these behaviours are often referred to as self-management (Lorig & Holman, 2003). Furthermore, examples of what patients could do to empower themselves in the health care domain were: 'participating in support groups, reading consciousnessraising books about health, and searching the internet for medical information' (Roberts, 1999;p. 86), although these reflected the writer's perspective and did not directly derive from patient perceptions.…”

“…To face up to this development governments of ageing populations need to adapt their health and care policies. A trend that can be observed is the rising focus of these governments on the encouragement of older adults to be in control of their health and health care (Angus & Reeve, 2006;Clark, 1987;Martin-Crawford, 1999;Roberts, 1999). In the Netherlands for instance, the current policy discourse stresses that older adults should function as independently as they possibly can (Da Roit, 2012).…”

Youth Empowerment in Oppressive Systems: Opportunities for School Consultants

“…Evidence shows that health outcomes in patient empowerment strategies take place through several pathways: directly -through improvements in individual decision-making efficacy, disease complication management and improved health behaviours (111)(112)(113)117,133) -and indirectly, through strengthened support groups, caregiver empowerment, enhanced satisfaction with provider/patient relationships and better access and efficient use of health services, with evidence of reduced utilization (111)(112)(113)116), enhanced self-education (134) and improved mental health outcomes (130,135). Mental health empowerment programmes that focus on advocacy place the patients in helping roles, which enhances their social support and quality of life and can create policy and practice changes such as improved quality of recreation services (136), new respite facilities, coalitions against stigma, and consumer rights policies (137).…”