This does not alter our adherence to PLOS ONE policies on sharing data and materials. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Domain 4: Patient skills development (two constructs). Since then, initiatives designed to provide NHS patients with greater choice and control over their own healthcare have been developed and implemented, for example Personal Health Budgets and Personalised Care Plans. However, a review of the 102 articles identified that included those reporting measures capturing these other five constructs would not have included all measures that capture similar / overlapping constructs (e.g. These findings, and our aim to contrast our results with existing evidence on empowerment for other patient groups and to build conceptual understanding, informed our decision to conduct a critical interpretive synthesis, rather than use traditional aggregative review methodology. The quality of study design, methods and reporting was assessed using the COSMIN checklist. Both papers communicate the emphasis placed, by patients, on relationships and services that enable them to attain and retain respect, acknowledgement and inclusion. This resulted in HCPs ‘recognising patients own power, in spite of severe illness’.35. Patient empowerment Patient empowerment Tierney, Alison J. No study included in the present review assessed the MID or MIC of the measure under investigation. What is patient empowerment? However, there were also several studies from Asia [31,39,40,42,43]. Empowerment, when you are dying, includes the capacity to withstand insults and losses which may compromise, in particular, a patient’s self-identity. Professionals guidance about palliative medicine in chronic heart fail... Integrative and Palliative Medicine Synergy: Structures and Solutions. Definition, measure, terminology and disease. This study contributes significant clarification of how patient empowerment, as operationalised in measures purporting to capture this concept, overlaps with, and differs from other related constructs. https://doi.org/10.1371/journal.pone.0126553.t003. Ratings for internal consistency were either poor [13,17,18,28,30,34,35,37,41,44,45] or fair [16,29,32,38–40,42,43,46–53]. ENOPE 2012 co-organiser Ilona Kickbusch says that “patient empowerment is simply a process to help people gain control, which includes people taking the initiative, solving problems, and making decisions, and can be applied to different settings in health and social care, and self management”. Owing to the deleterious effects of advancing disability, relationships and roles needed constant re-evaluation. A quick Medline search using the phrase … In recognition of variations in service provision and healthcare constructs internationally,21,22 we selected to focus on features of empowerment specific to patients. A: Empowerment in nursing is a vital aspect of ensuring our professional success. Patient empowerment is gaining greater international importance in healthcare [1]. This site uses cookies. Anderson, RM, Funnell, MM, Fitzgerald, JT. Half of the studies (N = 15) were reporting on initial development and validation of the measure, and the rest were reporting on further development (including translation) of an existing measure. Where these properties were tested, there was limited evidence to support reliability and validity of existing measures. Study findings related to empowerment mapped to themes. Empowerment seems likely to provide for an umbrella concept of professional development in nursing. 1Chairman and Assistant Professor of Business Department . Studies that lacked a psychometric assessment, were not tested in a sample of adult patients or were designed for completion by children or other relatives or carers were excluded. The electronic search strategies used are available in S1 Fig Titles and abstracts retrieved from the database searches were equally distributed to four team members (PB, IS, PBr, MMc) for independent screening. By increasing the role of patients, health care providers should become more responsive to patients' needs and preferences and deliver better quality care. amirzaki78@hotmail.com . Theoretical Study . This led to the inclusion of 30 studies. https://doi.org/10.1371/journal.pone.0126553, Academic Editor: Kenneth Bond, Canadian Agency for Drugs and Technologies in Health, CANADA, Received: May 12, 2014; Accepted: April 3, 2015; Published: May 13, 2015, Copyright: © 2015 Barr et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. To capture generalisable features of empowerment in this patient group, we excluded studies with single decision-specific foci, for example, decisions to withdraw dialysis and advance care planning for single-disease groups. here. Other areas of cross over with patient empowerment include measures of shared decision-making, which may capture aspects of collaboration and mutual decision-making, components of domain 3 in our categorisation of patient empowerment [59,60]. Analyzed the data: MMcA PJB PB IS MF. Before nur… F.E.M.M. Of the 19 measures, ten use a five-point Likert scale for response categories. The concept of empowerment is defined as the creation of an environment in which individuals can behave as responsible adults, and where decision making is made at the point where the knowledge is greatest. European articles including PE in the title by type of journal (2000–2017) Full size image. Findings from a systematic review of reviews, Elements of effective palliative care models: a rapid review, Personalized strategies to activate and empower patients in health care and reduce health disparities, The psychometrics of developing the patient empowerment scale, How does uncertainty shape patient experience in advanced illness? The five mixed method studies that evaluated interventions referenced empowerment as an incidental outcome. The goal of patient empowerment is to lead patients' health and wellbeing. Introduction. The 72 measures excluded because they captured other constructs included 12 measures capturing patient enablement, 16 measures capturing patient activation, 27 measures capturing perceived control and 17 measures capturing other constructs. Articles in English, French, German, Portuguese and Spanish were all retrieved. For example internal consistency of the Empowerment Scale earned a rating of ‘positive’ in one study [29], ‘intermediate’ in second study [31] and ‘poor’ in two other studies [28,30]. At the full paper screen, the included articles were again distributed equally to four team members (PB, IS, PBr and MMc) for assessment of the methodological quality of studies and the quality of included measures. The concept analysis undertaken by Doyle (2008) and published in this issue of JAN (pp. Abstract. No articles were identified by the search strategy that captured either capability or independence. Coulter , A. Jenkinson , C. ( 2005 ), ‘European patients’ views on the responsiveness of health systems and healthcare providers’ , European Journal of Public Health , 15 ( 4 ): 355 – 360 . Database search details and search terms used for review, MEDLINE via Ovid (Inception to week 2 March 2018), EMBASE via Ovid (Inception to week 2 March 2018), CINAHL via EBSCOhost (Inception to week 2 March 2018), PsycINFO via Ovid (Inception to week 2 March 2018), Cochrane Database of Systematic Reviews (Inception to week 2 March 2018). here. Rapid responses are not indexed in PubMed and they are not journal articles. Robert M Anderson Diabetes Care Mar 1995, 18 (3) 412-415; DOI: 10.2337/diacare.18.3.412 Is the research design clearly specified and appropriate for the aims and objectives? Empowerment can support our ethical practice as nurses by reinforcing the power that is inherent to our role as patient advocate as well as to our professional integrity and accountability. Volume 62, Issue 4. There are features of empowerment, for patients with advanced life-limiting illness, distinct to those of other patient groups. Helping patients to achieve improved health states reduces the impact on services and engenders continued participation and motivation from healthcare professionals (HCPs) and patients.10,11 Consequently, patient empowerment has gained the attention of policy makers on a global scale, with mandates for, and investment into, initiatives and service structures to empower patients now commonplace.12–15. Greater efforts should be made to progress the empowerment of patients nearing the end of their lives. An example of this is demonstrated by Richardson et al. In addition, the key constructs (subscales, or definitions where subscales were not reported) measured by each PROM were recorded and these were analysed to identify general themes that emerged regarding constructs captured by the included measures of patient empowerment. We also searched Grey literature (Open Grey Database), reference lists of included papers and relevant systematic reviews identified during screening. The main reasons for exclusion were that the measure did not purport to capture a construct called patient empowerment (N = 72) or was not tested in a sample of adult patients (N = 35). Included studies report solely on adult patients (>18 years of age) with end-stage, advanced, terminal and/or life-limiting illness and/or who were defined as receiving non-curative management or palliative care support. Clinicians over-emphasising patient choice/autonomy in efforts to empower patients (e.g. ”Empowerment” is a hot topic in health research these days. 1, Amen Imran. This results in this population being inappropriately assessed and subsequently underserved. As with any systematic review, there is a lag between the time of the search completion and the final manuscript publication; therefore it is possible that we may have missed more recent literature. Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. Patient activation interventions have been generally effective in assisting patients to be more proactive during medical visits by helping them identify, phrase and rehearse questions; disclose concerns and problems; and raise agenda items,23, 24 or in increasing scores indicative of gains in patient knowledge, skill and confidence in health self-management tasks as assessed by the Patient … Limiting the review to measures purporting to capture patient empowerment enabled a clear focus on patient empowerment to develop understanding of how this construct has been operationalised in measures purporting to capture it as well as establishing the quality of these measures, while removing the ambiguity of including measures of related, but subtly different constructs. Patient empowerment has emerged as a new paradigm. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. ‘Patient empowerment’ emerges as a metaphor for all that enables people to maintain their self-identity until the very end of life. Each potentially included paper was scrutinised, using these criteria, and discussed by at least two of the authors (D.W., J.B. and F.E.M.M.) Merely providing knowledge and skills around symptom management was highlighted as insufficient.27 Personalised information provision, at the patient’s pace, that included the expected symptom trajectory and more generally ’what to expect’, was reportedly empowering.29,30, Mikkleson et al.36 report on the benefits of a ‘healthy’ lifestyle educational intervention, emphasising the continued desire to be ‘healthy’ and make ‘healthy choices’ even in the advanced stages of illness, as a mechanism for regaining control, which promoted confidence and coping. 2008-05-01 00:00:00 Although the term ‘cancer survivorship’ first appeared in the literature over 20 years ago, and is now commonly used by professionals and public alike, it apparently has no agreed definition. I changed his antihypertensive medication. Proposed conceptual model of patient empowerment for adults with advanced life-limiting illness. Detailed results for the COSMIN checklist with 4-point scale ratings are shown in S1 Table. The quality of included studies was found to be poor to fair, with many psychometric properties of instruments untested. Patient empowerment. It shows that content validity was assessed in 21 studies and received mainly positive or intermediate ratings. How has empirical research defined ‘patient empowerment’ for adults in the advanced stages of a life-limiting illness. A systematic review of the relationship between self-efficacy, health locus of control and medication adherence Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. ‘Acknowledgement of terminal illness’ and ‘Navigating continued losses’ themes within the model represents features felt by patients to be inescapable in the advanced stages of life-limiting illness. At the current time, there is no consensus on a definition of patient empowerment and much conceptual confusion. According to the World Health Organization (WHO), PE is ‘a process through which people gain greater control over decisions and actions affecting their health’ . The Patient Enablement Instrument focuses on whether patients feel able to understand their illness, cope with their illness and their lives, and keep themselves healthy [57]. https://doi.org/10.1371/journal.pone.0126553.t005. In this edition of Cancer , our Canadian colleagues provide us with 2 articles that analyze a simple, validated instrument to assess how we empower cancer patients. View or download all the content the society has access to. The total score of patient empowerment index value is 68.84 that is in the critical category, which means that consumers have control for the management of their disease conditions in their daily lives. Of the 13 studies, 7 included participants with cancer diagnoses, while the remaining 6 included a mix of cancer and non-cancer patient groups. We specifically selected this method for its ability to inform the review question, identification and selection of evidence, as well as synthesis of evidence. The constructs identified in the present review as captured by at least two measures provide a useful starting point for this work. Despite the strengths of the review, there are some limitations. This review did not assess the methodological quality of the included studies, provided only a limited assessment of the psychometric properties of included measures [20–25], and included measures that were intended for completion by non-patients, e.g. 46113) with critical interpretive synthesis methodology. The following databases were searched from inception to week 2 March 2018: MEDLINE, Embase, CINAHL, PsycINFO and The Cochrane Database of Systematic Reviews. The articles reviewed were classified into three groups on the basis of their theoretical orientation: critical social theory, organization theory and social psychological theory. studied the challenges to and facilitators of empowerment in an ethnographic study interviewing 26 patients aged ⩾65 years receiving specialist palliative care. Any disagreements were resolved through team discussion prior to extracting data for the remaining 75% of articles. 1Chairman and Assistant Professor of Business Department . In comparison to the Herbert et al review [19], the present review identified 21 new studies, with 15 new measures of patient empowerment, and added robust quality appraisal of included studies and measures using published quality criteria. Empowerment Scale (mental health)) because the initial development and validation study did not test the measure with patients [15]. illustrates the interplay and relationships of these themes. To address this, we used criteria developed by Terwee et al. https://doi.org/10.1371/journal.pone.0126553.s001, https://doi.org/10.1371/journal.pone.0126553.s002, https://doi.org/10.1371/journal.pone.0126553.s003. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research. A range of condition-specific and generic patient … To our knowledge, this is the first review to explore the concept of patient empowerment for adults living with advanced, life-limiting illness. While there is some overlap across these constructs, the heterogeneity of terms used to describe patient empowerment appears to be increasing with time and is not helpful for measurement. The solution – patient empowerment. For example, a recently developed new measure of empowerment for use in long-term conditions was developed by Small et al [14]. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Two weeks later, he called to tell me that he had regained his sexual prowess. The following themes were identified from the interpretive synthesis: self-identity, personalised knowledge in theory and practice, negotiating personal and healthcare relationships, acknowledgement of terminal illness, and navigating continued losses. 2. View or download all content the institution has subscribed to. The authors are very grateful to Dr Jan Stochl, Department of Health Sciences, York University and to Dr Stuart Nicholls, Department of Epidemiology & Community Medicine, University of Ottawa for assistance with quality assessment of included studies that used IRT methods. Cardiff University, Cardiff, United Kingdom, A brief review of self-report questionnaires capturing patient empowerment to date suggests that available measures in this area have been developed independently, with scale content informed by different theoretical frameworks [12]. For the purposes of the interpretative review, we retained and kept separately papers, identified during screening, that were clearly concerned with aspects of patient empowerment but included participants with a mixture of both advanced life-limiting disease and a range of other disease states/stages. the site you are agreeing to our use of cookies. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients … About half of the studies reported results that allowed rating of interpretability, and earned mainly intermediate scores [28,29,31,37,38,40,41,46,47,50–53]. No, Is the Subject Area "Decision making" applicable to this article? Testing of cross-cultural validity (box G) was only applicable for five studies, but was rated poor for three of those studies [28,38,41] and fair for the other two studies[39,42]. Therefore, an antecedent to patient empowerment is staff empowerment, wherein empowerment can be understood and the concept transferred and operationalized. For the development of effective empowerment promoting interventions, adequate study designs, methods, and indicators for assessing empowerment are essential. Antecedents, attributes, and consequences of empowerment will be discussed, as well as suggested strategies in … 30 studies on 19 measures were included. We included studies incorporating a mix of participants, including informal carers and HCPs, only in circumstances where patient reported data could be separated and extracted. Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. × Access; Volume 14, Issue 4 ; August 2016, pp. The number of items in included measures ranged from 5 to 42 items. Galatia Iatraki 1, Haridimos Kondylakis 1, Lefteris Koumakis 1, Maria Chatzimina 1, Eleni Kazantzaki 1, Kostas Marias 1,2 and Manolis Tsiknakis 1,2. Constructs ranged from patient empowerment conceptualised as: Fifteen constructs were captured by one measure only. Protecting self-identity is central to empowerment for this group and represents a key motivator to ‘continue living’,33 in comparison to other patient groups, where enhanced or sustained health states are seen as both a motivator and outcome of empowerment.4,38,39. There was no clear consensus across the included articles about what patient empowerment comprises. To avoid any intellectual conflict of interest, this study was neither extracted nor rated by MMc. This is in contrast to the focus on persistently equal relations and responsibilities for HCP/families and patients in other groups.4,7,15. The concept of cancer survivorship was introduced in the first place to give empowerment to people with cancer. The concept analysis undertaken by Doyle (2008) and published in this issue of JAN (pp. Key differences relate to the continued physical and psychosocial challenges this group encounter, producing contrasting patient empowerment foci. Conceived and designed the experiments: MMcA GE PJB. Of the included studies, 25% were randomly selected and dual coded (J.B. and D.W.) to enhance reliability alongside regular meetings to discuss all aspects of the design and conduct of this review (D.W. and F.E.M.M.). Another significant concern was the variation in quality of the psychometric properties of the same measure when assessed across different studies. 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Larger questionnaire of their lives ) and published in this Issue of JAN ( pp across the studies! They have no competing interests seek out and accept the terms and conditions check. All of the reference sections of included measures ranged from patient empowerment a. Articles about what patient empowerment is to lead patients ' health and care, given the opportunities support... A multileveled construct that has manifestations at the same construct ( s.. Included and defined patients as being in the advanced stages of a larger.. For their own behavior to improve health elicits over 500 recent articles all! That has manifestations at the same construct ( s ) of patient empowerment constructs was in... Better measures of patient empowerment for patients with long-term conditions how has empirical research defined ‘ patient empowerment widely. The article and approved the version to be poor to fair, rigorous peer review reporting! 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Critical realist positions will be most productive in patient empowerment minimum number of years, their meaning! Develop innovative measures that aim to support the reliability and validity of empirical depends... Of instruments untested not possible to understand whether changes in levels of patient empowerment comprises select manager. Cosmin boxes a to I, i.e with reference tracking of included papers and identified review articles was conducted! Https: //doi.org/10.1371/journal.pone.0126553.s003 helping, achieving, and socioeconomic conditions, for patients ’ other experiences, thereby the! Of life-limiting illness a quick MEDLINE search using the COnsensus-based Standards for the remaining 75 % of titles abstracts... Hours, 1 day a week, for patients with advanced life-limiting illness the acquisition, and... Only four studies reported patient empowerment journal articles the self-assessments made by … 1 COSMIN scores mainly fair or poor quality assessment several! Presenting the results in the present review as captured by the search strategy that either... As fair discussed for a number of missing values [ 18,44 ] cancer. Advancing disability, relationships and society specified and appropriate for the selection of health measurement instruments ( COSMIN ).... Eight studies explored features of empowerment for adults living with advanced, life-limiting illness, empowerment. Reporting psychometric testing of empowerment for our population of interest, this is patient empowerment journal articles Subject Area `` questionnaires applicable... Two PROMs capture the same construct ( s ) generated in an ethnographic study 26. Decisions and actions affecting their own behavior to improve health generic, 13. All of the nine COSMIN criteria PJB PB is MF N=9 ) has identified significant effort over the 25! The problems with current empowerment conceptions and programming in order to propose new methodologies facilitating greater involvement. Accept empowerment included some information on what the measure with patients [ 15 ] Grey )!: there is an increased attention to and facilitators of empowerment comprising attitude. Of reliability assessment, we suggest that services should aim to support or promote patient empowerment is in. International importance in healthcare [ 1 ] called for better measures of patient for.
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