Concept Analysis of Empowerment From Survivor and Nurse Perspectives Within the Context of Cancer Survivorship

Effect of depression and empowerment on medication adherence in patients with breast cancer: a descriptive survey

BACKGROUND

Given the global prevalence of breast cancer and its high mortality rate, adherence to long-term anti-hormonal therapy is crucial for preventing recurrence and improving survival outcomes. Previous research demonstrates how psychological factors including depression and empowerment impact medication adherence. However, comprehensive studies remain limited, especially in Korea. This study explores the effects of depression and empowerment on medication adherence among patients with breast cancer undergoing anti-hormonal therapy.

METHODS

This descriptive survey involved 183 patients with breast cancer from one hospital in South Korea; participants were recruited using convenience sampling. Self-reported questionnaires were used to assess medication adherence, depression levels using the Korean version of the Beck Depression Inventory-II, and empowerment levels using a tool developed for women with breast cancer. Hierarchical regression explored relationships and influences between variables.

RESULTS

Participants demonstrated an average depression score of 19.67 ± 11.25, with medication adherence measured at 18.06 ± 5.15 and empowerment at 106.40 ± 18.15, revealing that, among patients with breast cancer, many experienced depression with varying levels: 16.9% mild, 27.3% moderate, and 21.9% severe. Medication adherence levels were distributed, with 58.5% of patients categorized as non-adherent and 41.5% categorized as adherent. The results indicated a significant negative correlation between depression and medication adherence and a positive correlation between empowerment and medication adherence. Higher empowerment levels were associated with improved adherence. Conversely, high depression levels were associated with low medication adherence.

CONCLUSIONS

This study enhances understandings of psychosocial factors influencing medication adherence in patients with breast cancer, highlighting patient empowerment as crucial for healthcare interventions. Thus, healthcare providers should implement targeted interventions including educational programs to inform patients about their treatment regimens, provide counseling services addressing mental health concerns such as depression, and establish support groups fostering a sense of community and shared experiences among patients. By integrating these strategies into patient care, healthcare professionals can significantly enhance patient empowerment and improve medication adherence toward better health outcomes for breast cancer patients. Future research could explore the long-term effects of these interventions on adherence and overall patient well-being.

Patient Empowerment in Cancer Care: A Scoping Review

BACKGROUND

Patient empowerment is receiving increasing attention in cancer care, and its relevance has led to a growing body of literature. Empowerment-related evidence, however, has not been comprehensively reviewed.

OBJECTIVE

The purpose of this scoping review was to summarize the available evidence on patient empowerment in cancer care. Specifically, we examined how patient empowerment has been defined and measured and what we have learned.

METHODS

We searched 6 databases (MEDLINE, PubMed, CINAHL, EMBASE, Cochrane Library, and PsycINFO), adapting key search terms (eg, "neoplasm," "empowerment") to each. Extracted data included author, publication year, country of data collection, main study purpose, study design, sampling method, setting, cancer trajectory, definition of empowerment and its source, measurement of empowerment, correlates, intervention (if applicable), and major results.

RESULTS

Of the 2987 articles we initially identified, we included 64 studies (18 quantitative, 9 qualitative, 9 psychometric validation, 8 mixed methods, 6 reviews, and 14 others). Across designs, randomized controlled trials were the most frequent. A comprehensive summary by study designs was provided.

CONCLUSIONS

The review highlights the importance of defining the empowerment concept, which is generally vague. There is a paucity of research on examining the relationship between empowerment and its related concepts. More nonexperimental studies (eg, cross-sectional, longitudinal, case-control studies) are required.

IMPLICATIONS FOR PRACTICE

Nurses are in an optimal position to engage in the process of empowerment, leading to its benefits. To achieve the best outcomes, nurses need to clarify the definition, select an appropriate measurement, and be trained in empowerment strategies.

The use of written guides to empower breast cancer survivors in their management of chronic pain: A realist evaluation

OBJECTIVE

Many breast cancer survivors experience long-term complaints following treatment, such as pain, which are often not addressed in a sufficient way. To empower survivors in talking about their pain and related complaints and in searching for appropriate support when needed, we developed two written guides. With this study, we aimed to pilot test the guides and gain insight into the implementation process and influencing mechanisms through the perspective of a realist evaluation.

METHODS

Nine survivors were interviewed at two time points (i.e., post-intervention and at three-month follow-up). The data were thematically analysed and categorized into a context-implementation-mechanisms-outcomes hypothesis.

RESULTS

The guides empowered the participants to discuss pain with medical specialists and initiate support-seeking behaviour through underlying mechanisms such as awareness, acknowledgment, hope, reduced isolation, and motivation. Nonetheless, mechanisms and outcomes differed according to a survivor's unique context.

CONCLUSION

Written guides can offer a feasible way to empower survivors in their management of chronic pain. However, a one-size-fits-all approach is not desirable and other strategies might be necessary.

PRACTICE IMPLICATIONS

It is pivotal to engage survivors as well as professionals in adopting new interventions. As such, the role of nurses in introducing and endorsing the guides should be further explored.

Empowering Cancer Survivors in Managing Their Own Health: A Paradoxical Dynamic Process of Taking and Letting Go of Control

In cancer care, gaps in support to help patients manage and live with the side-effects from cancer treatments have increased the emphasis on empowering patients to be more active and involved in managing their own health. However, empowerment in relation to promoting self-management behaviors is not well understood. Using the social constructivist grounded theory approach, our goal was to develop a theoretical understanding of this phenomenon in relation to the self-management behaviors of post-treatment cancer patients. Twenty-two post-treatment cancer patients participated in a semi-structured focused interview to co-construct with us how empowerment is defined, described, and experienced in relation to their capacity to self-manage. Through this co-construction, we defined empowerment as a process of personal growth, a display of fortitude and strength when participants confronted the impact of their illness that emerged in two dynamic and paradoxical ways: 1) establishing control over the impact of the illness as a means to maintain normalcy and to circumvent change over an eroding and changing sense of self and 2) relinquishing control over aspects of the illness deemed irrepressible and acknowledging and accepting change. When successful at establishing and/or relinquishing control, participants no longer viewed cancer as a threat, but re-interpreted their illness as also having a beneficial "empowering" experience and more capable of managing. Findings will guide the development of self-management interventions that use empowerment as a core construct.

Empowerment through technology: A systematic evaluation of the content and quality of mobile applications to empower individuals with cancer

OBJECTIVE

Greater emphasis on patient empowerment has led to a plethora of mobile health applications aimed at empowering patients with cancer. However, the rigor and evidence of these apps are rarely acknowledged. This systematic review of patient empowerment apps describes the characteristics, quality, heuristics, and evidence supporting these apps.

MATERIALS AND METHODS

We identified commercially available apps through the Apple and Google Play stores using patient- and research-derived conceptualizations of patient empowerment. Three authors used the Mobile App Rating Scale, heuristics, readability, user ratings, and evidence to evaluate the apps' foci, features, and quality. App characteristics were summarized with descriptive analyses.

RESULTS

Twelve apps met the eligibility criteria and were analyzed. Apps' content focused on enhancing communication skills (n = 10, 83.3%), social support (n = 8, 66.7%), information about cancer and treatment (n = 8, 66.7%), and peer-to-peer support (n = 5, 41.7%). The mean objective (3.9 ± 0.5 out of 5) and subjective (3.7 ± 1.0 out of 5) quality scores were moderate to high. Most heuristics were not violated, and the mean reading level was 10th grade, which is above the recommended 8th grade level. Four apps had been evaluated in published research articles.

DISCUSSION

The contents of patient empowerment apps varied greatly, and the readability was exclusionary to the average reader. Apps.

CONCLUSION

Patient empowerment apps should be more rigorously designed and tested to ensure the apps are usable and beneficial to diverse groups of cancer survivors.

The effect of telephone counselling and follow-up on empowering women with breast cancer undergoing chemotherapy

Empowering women with breast cancer leads to better adaptation to diagnosis and treatment, and reduces the symptoms of cancer. The purpose of the researchers is to determine the effect of a telephone counseling and follow-up program on empowerment of women with breast cancer undergoing chemotherapy. We used a non-randomized clinical trial design. Researchers applied the telephone counseling and follow-up to the intervention group for 8 weeks. At the end of study, the intervention group showed improvement in measures of cancer functional management and breast cancer specific function, along with satisfaction with the decision, general symptoms of cancer and specific symptoms of breast cancer.

The patient perspective: investigating patient empowerment enablers and barriers within the oncological care process

Patient empowerment is a multi-factorial concept and its relevance has led to a growing body of literature; despite this attention, there is still no agreement regarding the elements that define its expression. While several studies have already investigated the positive effect of empowerment interventions on the care process outcome, the aim of this study is to investigate which factors can foster an empowered management of the cancer condition from the patient's perspective. To examine patients' perception of empowerment enablers, we asked for participants' input on the role of three factors frequently cited as positively affected by empowerment: care quality, perception of direct control and relationships within the care context, during the care process. Three focus groups were conducted with 34 cancer patients. The results highlight the perception of direct control on their treatment as the least valued element (2.87, SD 0.566) when compared with care quality (3.75, SD 0.649) and relational support in the care context (3.91, SD 0.274). Unlike traditional approaches to empowerment, patient's expression of empowerment does not mainly reside in the direct control of their condition as much as in an active role within the relationship with caretakers, such as the ability to choose the doctor, the care team or the health organisation in charge of their healthcare. Emerging aspects from this analysis of patient's perspective are central in order to adequately consider empowerment in the care process and to provide more effective care strategies.

Empowering Patients to Co-Create a Sustainable Healthcare Value

Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with operators. This research aims to analyze the effects of patient empowerment on patients’ value co-creation behaviors. An empirical survey was conducted on 250 patients with chronic diseases in Italy. The results, analyzed using the structural equation modeling, showed that their empowerment enhanced value co-creation behaviors. Patients apply their health competencies and resources in their co-creation of health service with operators. It is, therefore, important to empower patients in their transformation from passive to active stakeholders, working with providers for the most optimal health outcomes. This research provides practitioners with suggestions for patient involvement which utilizes their knowledge, capabilities and responsibility to improving healthcare services.

A Chinese version of the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale: Reliability and validity assessment in chronically ill patients

AIMS AND OBJECTIVES

To translate the Patient Perceptions of Patient-Empowering Nurse Behaviours Scale (PPPNBS) into Chinese and to psychometrically test the Chinese version of PPPNBS (PPPNBS-C) in chronically ill patients.

BACKGROUND

The growing prevalence and burden of chronic illnesses became the driving force for the need of empowerment as an approach to engage patients in self-management. The PPPNBS was developed to assess patient perceptions of the process of empowerment during hospitalisation. Extending its application to different clinical context and ethnicities is worth pursuing.

DESIGN

A cross-sectional survey.

METHODS

The PPPNBS was translated according to Brislin's translation guidelines and was culturally adapted. A questionnaire survey was carried out to determine the reliability and validity of the PPPNBS-C among a total of 517 hospitalised patients with chronic illnesses.

RESULTS

The content validity was found to be good with a content validity index of 0.94. Exploratory factor analysis identified six factors explaining 68.56% of the total variance and confirmatory factor analysis confirmed this six-factor structure. The hypothesised differences were demonstrated through contrasted group comparisons by time since diagnosis and length of hospital stay. The score of the PPPNBS-C was significantly and positively associated with that of the Client Satisfaction Questionnaire, as was the Self-Efficacy for Managing Chronic Disease 6-Item Scale score, providing evidence of convergent validity. The Cronbach's alpha coefficient was 0.960 and the intraclass correlation coefficient was 0.86 for the total scale, explaining good internal consistency and time stability.

CONCLUSIONS

The PPPNBS-C has preliminary verification of the validity and reliability and could be useful in measuring patient perceptions of patient-empowering nurse behaviours.

RELEVANCE TO CLINICAL PRACTICE

The PPPNBS-C can be applied to chronically ill patients as a metric of the implementation status of patient-empowering nurse behaviours and can be used as a guide to encourage nurse's intentional utilisation of empowering behaviours.

Empowering cancer survivors to meet their physical and psychosocial needs: An implementation evaluation

Our Wellness Beyond Cancer Survivorship Program was established and evaluated as a quality improvement project. Individualized survivorship care plans for survivors and primary care providers included cancer surveillance recommendations and survivors' self-reported physical and psychosocial needs. At the discharge visit, an oncology nurse reviewed the care plan and symptom management strategies with survivors. We assessed the physical and psychosocial needs and feelings of empowerment of 70 breast and 53 colorectal cancer survivors on entry into the program and one year after discharge to primary care. Survivors were months to 10 or more years since the end of active treatment, with colorectal cancer survivors referred sooner (average 1.2 years). At baseline, colorectal cancer survivors reported little concern about their needs (scores <1.0 out of 5.0) and breast cancer survivors reported some concern about sleep disturbances, weight changes, memory/concentration changes, and fear of recurrence (scores 1.0 to 1.5 out of 5.0). All survivors reported feeling empowered (>3.0 out of 4.0). Needs and empowerment levels were mostly unchanged one year later. Colorectal cancer survivors showed a statistically significantly increased fear of recurrence at one year. In summary, cancer survivors with a survivorship care plan continued to feel empowered one year following discharge.

The excellence of patient-centered healthcare

Purpose

Nowadays, international healthcare agendas are focused on patient centeredness. Policies are aimed at improving patient’s satisfaction by enhancing patient empowerment and value co-creation. However, a comprehensive model addressing the relationships between these constructs has not so far been developed. The purpose of this paper is to develop and test a model which explains the effects of patient empowerment and value co-creation on patients’ satisfaction with the quality of the services they experience.

Design/methodology/approach

The links between patient satisfaction, empowerment and value co-creation are theoretically outlined via an in-depth literature review. The resulting model is tested through a survey administered to 186 chronically ill patients. The results are analyzed through covariance-based structural equation modeling.

Findings

The results show that patient empowerment positively influences value co-creation which, in turn, is positively related to patient satisfaction. In addition, the analysis reveals that patient empowerment has no direct effects on satisfaction.

Research limitations/implications

Although the cross-sectional design made it possible to clearly estimate the relationships among variables, it overlooked the longitudinal dimensions of co-creation processes.

Practical implications

The study provides practitioners with suggestions to design patient-centered healthcare services by leveraging on patient knowledge, participation, responsibility in care and involvement in the value-creation process.

Originality/value

Over the last decade, healthcare management literature has shifted its focus from healthcare organizations to patients. The number of contributions about patient satisfaction, empowerment and value co-creation exponentially increased. However, these dimensions are often studied separately. This work advances available knowledge by clarifying and testing the relationships between these three constructs.

Empowerment in Dermatology

The term empowerment refers to any process that facilitates behavioral changes and encourages responsibility and making informed choices. The concept has been applied mainly to help patients with chronic conditions achieve therapeutic goals. The aim of the approach in health care is to enhance self-caring and self-efficacy. The term derives from the English verb to empower meaning "to give (someone) the authority or power to do something" or "to make an individual or a group stronger or more powerful". One of the responsibilities of health professionals is to improve patients' knowledge and their ability to choose between the different alternatives available to them so that they can act accordingly. In this article, we review the various definitions of the term empowerment, the tools used to measure patient empowerment, the implications of the concept for the management of chronic disease, and its use in dermatological conditions.

Nurses’ Experiences Empowering Hospitalized Patients

Four focus groups were conducted to explore acute care nurses’ experiences empowering patients and the facilitators and barriers they encountered during the process. Thirty-four nurses employed at four hospitals in the Midwestern United States participated in the study between February and April 2015. Facilitators of empowerment included establishing a therapeutic relationship, fostering communication, providing education, respecting patient autonomy, engaging support systems, and lifting spirit/giving hope. Barriers included conflicting information about plans of care, lack of time, fear and anxiety over unfamiliar environments and routines, ineffective or inadequate support systems, lack of/low accountability, and killing the soul. Nurses also described innovative strategies they used to overcome the barriers. The development of future inpatient empowerment interventions needs to focus on the innovative strategies nurses used to overcome barriers in addition to considering the facilitators and barriers to empowerment that nurses identified.

Concepts and measures of patient empowerment: a comprehensive review

Abstract OBJECTIVE Analyze the definitions and dimensions of empowerment. Identify the strengths and weaknesses of empowerment measures based on the conceptual model. METHOD This was a comprehensive literature review of publications on the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Twenty-nine articles were selected. Seventeen definitions and seven dimensions of empowerment, and 10 empowerment measures were selected. Empowerment can be seen as an enabling process involving a shift in the balance of power, or as an outcome of this process. The dimensions reflect outcome indicators, such as participation in decision-making and control, and process indicators, such as knowledge acquisition and coping skills. Six of the tools analyzed by this study could be said to provide a robust measure of patient empowerment. CONCLUSION we propose a definition of empowerment that helps to deepen understanding of the term and, therefore, its operationalization.

[Development and Validation of the Empowerment Scale for Woman with Breast Cancer]

PURPOSE

The purpose of this study was to develop a scale to evaluate empowerment in woman with breast cancer and to examine the validity and reliability of the scale.

METHODS

The development process for the initial items included a literature review, interviews, and construction of a conceptual framework. The identified items were evaluated for content validity by experts, resulting in 3 factors and 48 preliminary items. Participants were 319 women with breast cancer recruited to test reliability and validity of the preliminary scale. Data were analyzed using item analysis, confirmatory factor analysis, criterion related validity, internal consistency and test-retest reliability.

RESULTS

The final scale consisted of 30 items and 3 factors. Factors, including 'intrapersonal factor' (14 items), 'interactional factor' (8 items), and 'behavioral factor' (8 items), were drawn up after confirmatory factor analysis. Goodness of fit of the final research model was very appropriate as shown by χ²/df=1.86, TLI=.90, CFI=.92, SRMR=.06, and RMSEA=.05. Criterion validity was evaluated by total correlation with the Cancer Empowerment Questionnaire .78. Cronbach's alpha for total items was .93 and test-retest reliability was .69.

CONCLUSION

Findings from this study indicate that the scale can be used in the development of nursing interventions to promote the empowerment of women having breast cancer.

Patient-Provider Communication: the Rise of Patient Engagement

OBJECTIVES

To describe the changing dynamics of patient-provider communication with proposals for optimizing this important relationship.

DATA SOURCES

Current research, national programs and guidelines from the National Cancer Institute, the Commission on Cancer, the Institute of Medicine, and the Oncology Nursing Society.

CONCLUSION

There are important opportunities to apply evidence-based strategies to optimize patient-provider communication that will result in improved health outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses across all areas of practice, including clinical care, research, and education, can play a significant role in achieving the goal of positive health outcomes by addressing challenges that inhibit effective patient-provider communication.

Empowerment of Cancer Survivors Through Information Technology: An Integrative Review

BACKGROUND

Patient empowerment may be an effective approach to strengthen the role of cancer survivors and to reduce the burden on health care. However, it is not well conceptualized, notably in oncology. Furthermore, it is unclear to what extent information technology (IT) services can contribute to empowerment of cancer survivors.

OBJECTIVE

We aim to define the conceptual components of patient empowerment of chronic disease patients, especially cancer survivors, and to explore the contribution of existing and new IT services to promote empowerment.

METHODS

Electronic databases were searched to identify theoretical and empirical articles regarding empowerment. We extracted and synthesized conceptual components of patient empowerment (ie, attributes, antecedents, and consequences) according to the integrated review methodology. We identified recent IT services for cancer survivors by examining systematic reviews and a proposed inventory of new services, and we related their features and effects to the identified components of empowerment.

RESULTS

Based on 26 articles, we identified five main attributes of patient empowerment: (1) being autonomous and respected, (2) having knowledge, (3) having psychosocial and behavioral skills, (4) perceiving support from community, family, and friends, and (5) perceiving oneself to be useful. The latter two were specific for the cancer setting. Systematic reviews of IT services and our additional inventory helped us identify five main categories: (1) educational services, including electronic survivorship care plan services, (2) patient-to-patient services, (3) electronic patient-reported outcome (ePRO) services, (4) multicomponent services, and (5) portal services. Potential impact on empowerment included knowledge enhancement and, to a lesser extent, enhancing autonomy and skills. Newly developed services offer promising and exciting opportunities to empower cancer survivors, for instance, by providing tailored advice for supportive or follow-up care based on patients' input.

CONCLUSIONS

We identified five main components of empowerment and showed that IT services may especially contribute to empowerment by providing knowledge. The components of empowerment could be used to develop IT services for cancer survivors. It is important to take into account patients' needs, follow up on these needs, and create a service that is attractive and easy to use.