Obrázok, na ktorom je text Automaticky generovaný popis Patient empowerment as an ethical approach to healthcare Field of study: Management in healthcare Academic year: 2021/2022 Name and surname: Bc. René Molnár (M20872) Subject: Healthcare Ethics Teacher: doc. Ing. Alena Klapalová, Ph.D. Introduction Ethics has accompanied medicine since its antique origins. Nowadays, it is often substituted for morality both in everyday language and professional literature. Ethics is a conscious response to morality. It critically examines value attitudes, norms, and principles to evaluate a given action and its assumptions. Ethics as a philosophical discipline is the science of moral action, and it does not justify the rightness of action by referencing to religious authority, tradition, or other institutions. The above is true of ethics in healthcare, and its specificity is due to the fact that it relates to medicine and the practice of the medical profession (Kuře, 2018). Patient-centred healthcare is becoming a priority for modern healthcare facilities. The relationship between a patient and a doctor is undergoing a fundamental shift. The patient moves from a more passive position to an active one in the process of taking care of his health. The development of technology, especially the Internet, has brought the so-called patient 2.0, who searches for health information online. He seeks this information to deepen his knowledge of his disease and obtain a second opinion, especially when he is not satisfied with the information provided by the doctor (Buccoliero et al., 2016). With the development of social networks, especially Facebook, the so-called patient 3.0, considered an equal partner of the medical staff, is also being mentioned. These patients use social networks to search for and communicate with patients with similar illnesses or experiences (Clemensen et al., 2016). The term Health 2.0 or Medicine 2.0 is also used in this context, which represents a shift to more personal and participatory healthcare (Stump, Zilch & Coustasse, 2012). Patients who sought information online and then had the opportunity to consult with their physician were more satisfied with the chosen therapy. This approach facilitates the choice of therapy that the patient prefers (Zoghlami, Ayeb & Rached, 2019). The increased connectivity and better information enable patient empowerment (Buccoliero et al., 2016), which can support a healthier lifestyle and improve the patient's ability to manage complications associated with the disease (Zoghlami, Ayeb & Rached, 2019). The purpose of this essay is to present the importance of the concept of patient empowerment, which can be seen as part of an ethical approach to healthcare. Such an approach is based on the idea that the patient should also have the right to equal status with healthcare professionals from an ethical point of view. Text of the essay Patient empowerment and ethics Ethical issues are critical to the sustainable development of healthy behaviours, practices, and policies that promote and maintain healthy lifestyle. This has long been recognised in the context of the challenges of the doctor-patient relationship and is increasingly relevant to public health programmes. It is argued that the best-known representations of public health ethics in their current form do not serve participation initiatives well. Citizens (as actual or potential patients and members of the public) need to be better supported in identifying and addressing the many value-based challenges they face in engaging in healthcare. This approach is fundamental when the issues under discussion concern individual autonomy and choice. If the potential of private and public participation in their health is to be harnessed, developing a healthcare ethic is necessary (Williamson, 2014). Patient empowerment is intended to offer patients more control and autonomy in their healthcare and decisions about their therapy (Ayed and Aoud, 2017). The position of patients is undergoing a fundamental change (Griffiths et al., 2012). The Internet provides better access to health information. At the same time, the increase in online support groups and a rise in spending on alternative therapy signal the patient's transition to an active role in their healthcare (Ouschan, Sweeney & Johnson, 2006). The demand for better information and increased patient rights is apparent and points to the importance of the patient's opinion, which the physician should consider when deciding on patient's therapy (Zoghlami, Ayeb & Rached, 2019). It is possible to define patient empowerment as a process that helps people gain control of their own lives and increases their ability to act on issues they consider essential (Daruwalla et al., 2019). Empowerment is proposed in order to make patient therapy more effective and at the same time to help with voluntary behaviour change. It enables patients to develop knowledge, skills, and abilities, strengthen dialogue and increase autonomy to control the determinants of their quality of life (Ayed & Aoud, 2017). Thanks to technological progress, information sources and communication channels, which are more easily accessible, play an essential role in this process (Zoghlami, Ayeb & Rached, 2019). New technologies make it possible to improve communication between doctor and patient. This helps to even out the differences in their respectful positions (Li, James & McKibben, 2016). Informed patients are also more actively involved in decision-making about their health (Zoghlami, Ayeb & Rached, 2019). Benefits of patient empowerment There are several driving forces for patient empowerment efforts (Daruwalla et al., 2019). Suppose people are able to take better care of their health through the improved distribution of information. In that case, the number of redundant visits to medical facilities and the workload of medical staff will be reduced (Zoghlami, Ayeb & Rached, 2019). One of the most tangible benefits of patient empowerment is its ability to increase the efficiency of the healthcare and the allocation of resources, thanks to which it is possible to achieve a reduction in the costs of patient care (Daruwalla et al., 2019). However, patient empowerment should not be assessed solely in terms of resource optimization and cost reduction (Tartaglione et al., 2018). The significance lies primarily in the benefits for the patient. A patient actively involved in self-care shows greater compliance with diagnosis and therapy (Zoghlami, Ayeb & Rached, 2019), which results in consequent better treatment outcomes, increased quality of life, and trust in healthcare professionals (Tartaglione et al., 2018). The most vital driving force in the approach to patient empowerment should be the ethical aspect, as it is appropriate to strengthen patients' autonomy, control, and participation (Daruwalla et al., 2019). Many physicians quickly forget what it is like to be a patient and how important it is to approach the patient as a person and not an object. According to Tartaglione (2018), empowering the patient has a positive effect on value co-creation, which positively affects patient satisfaction. For example, suppose the service is co-created and consistent with customer needs. In that case, the effort expended on the co-creation process is perceived as a rewarding experience beyond a simple evaluation of the service (Tartaglione et al., 2018). Patient-centred care has shifted the discourse towards strengthening the patient's position by supporting patient independence and enabling independent care. The role of patient empowerment has been studied in detail in various specific cases, especially in chronic diseases such as diabetes mellitus and chronic cardiovascular diseases (Risling et al., 2017). The traditional authoritative relationship, which may be appropriate in acute cases, is unsuitable for chronic diseases that require patients to be independent in taking care of their health (Ouschan, Sweeney & Johnson, 2006). Chronic diseases require a considerable degree of self-care, and cooperation between physician and patient is necessary for effective therapy and the use of health services (Ippolito, Smaldone & Ruberto, 2020). Research models show that healthcare facilities should perceive patient family members as an element influencing patient decisions. The decision based on the joint participation of the family brings greater satisfaction for the patient and his family (Kang & Choy, 2015). Therefore, appropriate choice of communication is necessary, especially with patients who want to participate more actively in decisions about their health. However, such communication requires more time with the patient, and here we encounter an obstacle. Physicians typically have only a limited amount of time reserved for each patient, and more appropriate communication could be at the expense of other patients (Anderson, Rayburn, and Sierra, 2018). For this reason, it is also necessary to direct patients to trusted sources (Zoghlami, Ayeb & Rached, 2019), where they could seek additional information and, if necessary, consult experts. It is the provision of sufficient information that can strengthen the position of the patient and his family (Grover, 2016). Necessity of feedback For the effective functioning of any company, including those in healthcare, it is desirable to receive feedback from customers about its products, services, and the company itself. Based on this feedback, the company can make progress and better satisfy its customer (Kotler and Keller, 2013). A traditional way to get customer feedback is the measurement of patient satisfaction, which reflects the degree to which patients' expectations of a healthcare facility are met. These expectations are formed based on personal experiences and information obtained from acquaintances, the Internet, or other sources (Borovský and Smolková, 2013). Expectation management is to achieve the smallest possible gap between patients' expectations and actual experiences. Meeting expectations is an essential contributor to developing a mutually beneficial relationship between healthcare providers and patients (Astuti and Nagase, 2016). Patients often share their satisfaction with their family, friends, and acquaintances. For healthcare facilities to prevent the spread of negative impressions, it is advisable to offer the opportunity for feedback, whereby perceived shortcomings can be addressed. There are many methods by which healthcare facilities can measure their patients' satisfaction. In-person or telephone enquiries, as well as e-mail communication, provide an opportunity to confront the criticisms of a given patient directly. However, a significant drawback is the risk of insincerity, which is why it is advisable to combine these methods with an anonymous questionnaire survey (Borovský and Smolková, 2013). This feedback is essential for every healthcare provider as well as healthcare professionals. If properly addressed, it provides an opportunity for improvement. This approach also enables patients to be more invested and feel like their opinion matters. Importance of patient empowerment The growing interest in research of this area also indicates the importance of patient empowerment. The WHO (World Health Organization) has included patient empowerment and patient-centred care among the critical elements in its Health 2020 policy framework (Risling et al., 2017), recognizing its role in improving health outcomes, increasing satisfaction, improving communication and compliance, as well as optimizing the use of resources and reducing costs (Tartaglione et al., 2018). However, it also points to the need to improve methods of measuring this area, as there is still no adequate method (Risling et al., 2017). Healthcare organizations and governments should take measures to promote patient empowerment. First and foremost, it is essential to provide patients with sufficient information to improve health literacy. Educating patients will give them more independence and control over their healthcare. To this end, it would also be appropriate to encourage the active participation of patients in the process of prevention, diagnosis, and therapy through communication oriented towards dialogue and joint decision-making (Tartaglione et al., 2018). This model of shared decision-making relies not only on medical data and research when choosing a therapy but also on the values and experiences of the patient (Zoghlami, Ayeb & Rached, 2019). Involving the patient in the whole healthcare process also contributes to greater trust (Ouschan, Sweeney & Johnson, 2006). Conclusion Patient empowerment represents one of the most important modern trends in medicine. The relationship between the patient and the workplace, or the physician directly, evolves positively when the patient feels that he or she is being listened to and has gained something of value. The patient's proactive approach to their diagnosis and therapy leads to better cooperation and treatment outcomes (Astuti and Nagase, 2016). Patient empowerment is proposed not only to make the patient's therapy more effective but also as an aid to voluntary behaviour change. This concept is intended to offer patients more control and autonomy over their healthcare and decisions about their therapy (Ayed and Aoud, 2016). The development of technologies such as smartwatches that allow patients to monitor their health, and the expansion of awareness and options through the internet, have resulted in patients moving from a passive to an active role in their healthcare. The opening of borders and the internet have also brought higher expectations from patients (Anderson, Rayburn, and Sierra, 2018). To this end, the new opportunities that come with the development of technology can also be taken. For example, smart devices that measure various health indicators could give patients more control and make them active participants in taking care of their health. It will be up to the clinician to research the capabilities and credibility of the available devices that the patient may encounter (Apple Watch, Withings Move ECG). A very beneficial, albeit more complex and probably more costly solution would be for patients to share such data with the doctor remotely. The ability to share this data will become increasingly important as "smart" devices become widespread. If healthcare facilities are interested in using these possibilities, the current legal framework and, in particular, the GDPR rules need to be taken into account. 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