The goals of patient-centred care require us to focus on the expressed needs and preferences of the patient, rather than on the needs and preferences of healthcare services or healthcare professionals. In this chapter we discuss the growing importance of patient engagement and patient empowerment, which for many patients represent two essential components of patient-centred care. Both engagement and empowerment stress that healthcare professionals and patients work in partnership to promote and support patients' active involvement in advancing their health and healthcare. The definitions used for these terms are not universally agreed but some clarity is emerging,1 which is discussed in this chapter. It is useful to differentiate between the two terms. 'Engagement' expresses the commitment and actions of healthcare professionals to include patients in discussions and decisions about their care as individuals and in the development ('co-production') of plans for healthcare services. Patient engagement positively shapes the interactions between patients, healthcare professionals and healthcare services. 'Empowerment' is a wider, more complex concept that encompasses commitment and action by patients that are self-derived and self-driven and may occur outside the interactions with healthcare professionals. 'Engagement' and 'empowerment' overlap, interact and strengthen each other. The degree of empowerment or engagement that is desirable for an individual depends on the person's preferences and experience.
Angela Coulter writes on patient engagement and comments that most patients want to play an active role in their healthcare: they want to know how to protect and improve their health when they are well; when they are ill, they want information about the treatment options and likely outcomes; and, in addition to seeking fast, effective health advice and care when they need it, most people want to know what they can do to help themselves.2 Patient engagement therefore involves ensuring the following:
Care delivery by healthcare professionals is always responsive to people's physical, emotional, social and cultural needs.
Staff interactions with patients are empathetic and informative.
The patient's personal values and preferences are elicited and acted upon.
The goal is to understand what matters most to patients, and that healthcare professionals re-orient service goals based on that understanding. This is well articulated in the UK on the INVOLVE website (www.invo.org.uk).
The European Patients' Forum (EPF) writes on patient empowerment and comments that it is defined in multiple ways depending on the context and objectives. The EPF defines empowerment as a 'process that helps people gain control over their own lives and increases their capacity to act on issues that they themselves define as important'. The EPF also sees empowerment as a relational concept, in which the patient's environment plays a critical role. Aspects of empowerment include health literacy and a growing recognition of the value of shared decision making and self-management.3 The EPF has developed a Charter on Patient Empowerment which characterizes ...