Institute of Cancer & Genetics, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
BMC Health Serv Res. 2012 Jun 13;12:157. doi: 10.1186/1472-6963-12-157.
Health policy in the UK and elsewhere is prioritising patient empowerment and patient evaluations of healthcare. Patient reported outcome measures now take centre-stage in implementing strategies to increase patient empowerment. This article argues for consideration of patient empowerment itself as a directly measurable patient reported outcome for chronic conditions, highlights some issues in adopting this approach, and outlines a research agenda to enable healthcare evaluation on the basis of patient empowerment.
Patient empowerment is not a well-defined construct. A range of condition-specific and generic patient empowerment questionnaires have been developed; each captures a different construct e.g. personal control, self-efficacy/self-mastery, and each is informed by a different implicit or explicit theoretical framework. This makes it currently problematic to conduct comparative evaluations of healthcare services on the basis of patient empowerment. A case study (clinical genetics) is used to (1) illustrate that patient empowerment can be a valued healthcare outcome, even if patients do not obtain health status benefits, (2) provide a rationale for conducting work necessary to tighten up the patient empowerment construct (3) provide an exemplar to inform design of interventions to increase patient empowerment in chronic disease. Such initiatives could be evaluated on the basis of measurable changes in patient empowerment, if the construct were properly operationalised as a patient reported outcome measure. To facilitate this, research is needed to develop an appropriate and widely applicable generic theoretical framework of patient empowerment to inform (re)development of a generic measure. This research should include developing consensus between patients, clinicians and policymakers about the content and boundaries of the construct before operationalisation. This article also considers a number of issues for society and for healthcare providers raised by adopting the patient empowerment paradigm.
Healthcare policy is driving the need to consider patient empowerment as a measurable patient outcome from healthcare services. Research is needed to (1) tighten up the construct (2) develop consensus about what is important to include (3) (re)develop a generic measure of patient empowerment for use in evaluating healthcare (4) understand if/how people make trade-offs between empowerment and gain in health status.
英国和其他国家的卫生政策优先考虑增强患者权能和患者对医疗保健的评价。患者报告的结果测量指标如今在实施增强患者权能的策略中占据核心地位。本文主张将患者权能本身视为衡量慢性病患者的直接可测量结果，强调采用这种方法所存在的一些问题，并概述了一个研究议程，以便能够基于患者权能进行医疗保健评估。
患者权能不是一个定义明确的概念。已经开发出了一系列针对特定疾病和通用的患者权能力量表；每个量表都捕捉到不同的构念，例如个人控制、自我效能/自我掌控，并且每个构念都受到不同的隐含或显式理论框架的影响。这使得目前基于患者权能对医疗保健服务进行比较评估变得具有挑战性。通过案例研究（临床遗传学）来说明：即使患者没有获得健康状况的改善，患者权能也可以成为有价值的医疗保健结果；为开展必要的工作提供了依据，以收紧患者权能构念；提供了一个范例，为增加慢性病患者权能的干预措施的设计提供了信息。如果将该构念恰当地作为患者报告的结果测量指标进行操作，此类举措就可以基于患者权能的可测量变化进行评估。为此，需要开展研究，以开发一个适当且广泛适用的通用患者权能理论框架，为（重新）开发通用的衡量指标提供信息。这项研究应该包括在操作化之前，在患者、临床医生和决策者之间就构念的内容和边界达成共识。本文还考虑了采用患者权能范式给社会和医疗保健提供者带来的一些问题。
医疗保健政策推动了将患者权能视为医疗保健服务的可衡量患者结果的需求。需要开展研究：（1）收紧构念；（2）就重要内容达成共识；（3）（重新）开发用于评估医疗保健的通用患者权能力量表；（4）了解人们在增强权能和健康状况改善之间如何进行权衡。
