Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, B.C, Canada.
Int J Health Plann Manage. 2022 Dec;37 Suppl 1:20-31. doi: 10.1002/hpm.3509. Epub 2022 May 28.
Patient engagement in healthcare planning and evaluation has been promoted as a way to improve healthcare's ability to meet patients' needs. However, populations experiencing oppression and discrimination, such as racism, colonialism, sexism, heterosexism, cisnormativity, ableism, classism, and poverty, are often underrepresented in patient engagement spaces. The context and structure of patient engagement processes may systematically exclude certain populations from participating in meaningful ways or from participating at all. By excluding certain populations from active, meaningful patient engagement, we risk planning and evaluating health services on the basis of the values, needs, and preferences of the dominant population. This, in turn, will further entrench health inequities and preclude the ability to surface ideas that challenge dominant conceptualisations of health and healthcare, thereby reinforcing the status quo rather than promoting healthcare transformation. Recognising that experiences of health, healthcare, and patient engagement processes are mediated through gender, race, ability, sexual orientation, and other dimensions of diversity, it is proposed that processes for engaging patients in healthcare planning and evaluation must by intersectional, attend to systemic and power relations, and truly put patients in the driver's seat of engagement processes. Health services planners and evaluators need to create more inclusive, accessible, and appropriate patient engagement experiences in order to focus on transforming healthcare towards a more socially just system.
患者参与医疗保健规划和评估已被提倡为改善医疗保健满足患者需求的能力的一种方式。然而，那些经历压迫和歧视的人群，如种族主义、殖民主义、性别歧视、异性恋主义、常态主义、残疾歧视、阶级歧视和贫困，往往在患者参与空间中代表性不足。患者参与过程的背景和结构可能会以系统的方式将某些人群排除在有意义的参与之外，或者完全排除他们的参与。通过将某些人群排除在积极、有意义的患者参与之外，我们有可能会根据主流人群的价值观、需求和偏好来规划和评估卫生服务。这反过来又会进一步加剧健康不平等，并排除提出挑战主导健康和医疗保健观念的想法的能力，从而强化现状，而不是促进医疗保健转型。认识到健康、医疗保健和患者参与过程的体验是通过性别、种族、能力、性取向和多样性的其他方面来调节的，有人提议，必须通过交叉性、关注系统性和权力关系、并真正让患者成为参与过程的主导者，来参与医疗保健规划和评估的患者。卫生服务规划者和评估者需要创造更具包容性、可及性和适当性的患者参与体验，以专注于将医疗保健转向更具社会公正的系统。
