Patient competence
The patient competence deals with the independent contribution of the patients to recovery as a necessary complement, rather than compete with the achievements of medicine. The term was coined by cancer patients around the year 2000. Around the same time, the synonymous term the expert patient was established in the English-speaking world . Competent patients ask themselves what they can contribute to coping with illness and recovery.
The most important conceptual template for understanding the nature of patient competence is the so-called 2-doctor model. It states that two doctors must work together to successfully cope with the disease, the external doctor, the medicine, and the "internal doctor", the patient's self-healing potential. While medicine strives for healing through the treatment of the disease , patients primarily want to activate healing health forces. The most common question from competent patients is: What can I do for myself? It is the question of personal resources to successfully deal with the new life situation caused by the illness.
Patient competence needs to be learned. The corresponding process is called empowerment or self- empowerment .
The still relatively new term patient competence is related to a social trend that manifests itself not only in health care , but also in many other areas of life of our time: This is the replacement of binding collective clichés in favor of individually designed ways of life. Increasing patient competence represents a particular challenge for medicine, which is still characterized today by a traditional, paternalistic self-image.
history
Since the middle of the 20th century, various terms have successively described the changing role understanding of patients:
- 1960: The patronized patient : Until the middle of the 20th century, the patient did not play a self-determined role. In each case, the medicine itself was decisive for the medical process. The patient, on the other hand, participated as a passive member in the healthcare system. He gave up his identity upon entering the medical world. He was often not given serious diagnoses. His illness belonged to medicine.
- 1970: The informed patient : During this time, the informed consent coming from the USA, i.e. the obligatory information of the patient about the disease and the medical measures, was also introduced in Europe.
- 1980: The responsible patient : informed cancer patients founded the first cancer self-help groups . At first they were mainly concerned with having a say. As a result, lawyers began to increasingly grapple with patient rights.
- 1990: The autonomous patient : The increasing emancipation of patients led to the model of shared decision-making , which is understood as the joint decision-making of doctor and patient. One spoke of medicine on an equal footing. To do this, the ability to dialogue between patient and medicine had to be established. For example, the language of medicine had to become more popular and the informational texts in package inserts more understandable for laypeople.
- 2000: The competent patient : Until about the year 2000, the patient movements were mainly about patient rights , about treating patients as individuals rather than numbers and about their role in health care - in other words, about the behavior of patients towards other people or health care institutions.
The terms patient competence, competent patient and self-empowerment have expressed an expanded understanding of the role of patients since the beginning of the 21st century. You are now increasingly asking yourself about your own behavior not only in relation to the outside world, but also in relation to yourself and your own possibilities, duties and scope for action in the illness. The term patient competence indicates the assumption of personal responsibility in coping with illness.
Definitions
The term patient competence (PK) comes from cancer patients themselves. It largely coincides with the term the expert patient, which is used in English-speaking countries . Today there are essentially three definitions of PK:
- Cancer patients have defined PK themselves as follows: PK is the ability to lead a normal life with and despite illness, handicap or trauma . This definition essentially means the successful attempt to accept the new reality of life caused by the illness, to align everyday life with this reality and to help shape the new life situation using one's own resources.
- Medicine and psycho-oncology define PK more precisely:
PK encompasses the ability
- to face the challenges of the disease,
- to reflect on one's own and other people's resources for coping with illness,
- to use these resources
- to consider one's own needs in the illness,
- to pursue your own goals as well as
- to maintain autonomy.
- The social psychology describes as follows the term PK: PK includes as individual skills personal skills, relationship skills, social skills and democratic competence.
These three descriptions show that there is still no generally binding definition for the term patient competence, but work is being carried out on operationalizing it.
The three typical questions of competent patients
Competent patients typically ask three questions:
- Who will orient me in the information jungle?
- How do I find my personal path through illness?
- What can I do to help cope with illness myself?
Competent patients do not want to be “little doctors”. You don't want to make medical decisions. But they want to be able to understand this. They want to be experts, not in medical matters, but in their own affairs. They expect the doctor to respect their personal thinking styles and behavioral patterns, just as, conversely, they respect medical expertise .
Self-empowerment and resources
Not only patients, but most people in our western world assume that they have the body's own strength to cope with life crises, including diseases. In the event of illness, recovery is not only made possible by medicine, but also by the patient as a co-producer of health . The term self-empowerment refers to the ability to discover and strengthen one's own health-making powers and use them specifically to cope with illness. More and more information is now available to patients, especially online. That is why there are more and more people who use the new media and social networks to find out more about their illness and the promotion of their quality of life, who are actively improving their health literacy and who are joining forces to form online communities.
Instead of the patient formulation “the body's own strength to increase the defense”, medicine tends to use the term resources to cope with illness. Many patients are initially unaware of these resources. Discovering them together with the patient and making them aware of them is the central goal of empowerment counseling. Offering resources and encouraging patients to develop their skills and shape their own lives is also known as patient empowerment .
Models of patient competence
The behavior of competent patients is primarily influenced by two ideas, firstly the model of 2 doctors, secondly the model of the prognostic relevance of patient competence.
The "2 doctors" model
Above all, the “2 doctors” model is of central importance for understanding the thinking styles of cancer patients, their behavioral patterns and complementary therapy expectations. It says that two doctors are necessary to cope with cancer: the "external doctor" (the medicine with its possibilities) and the "internal doctor" (the patient's self-healing potential, also known as the body's own defense or internal healer). This 2-doctor model is ancient and is reflected, for example, in the Latin proverb medicus curat, natura sanat (the doctor treats, nature (of man) heals). The action of Western medicine ( conventional medicine ) is primarily oriented towards the discovery and treatment of diseases - it is about the disease in humans. It is therefore also called pathotropic, that is, disease-centered. The actions of patients, on the other hand, are more aimed at strengthening the body's own health-making powers - this is why it is also called salutotropic, i.e. health-centered. And that is why topics such as defense, detoxification, nutrition, exercise or medication and methods for strengthening their own resources are so important for patients.
The model of the prognostic relevance of patient competence
In addition to the 2-doctor model, the certainty of being able to influence their own personal fate characterizes the behavior of competent patients. This certainty is only evident from everyday experience. A common flu usually goes away without medical help. Wounds heal by themselves. Soul pain passes after an adequate period of mourning. Even with a disease like cancer, which is perceived as disastrous like hardly any other, the belief in the prognostic relevance of patient competence is very strong - at least in the early stages. According to conventional medicine, however, the course of breast cancer, for example, depends on three prognostic categories:
- Tumor markers: histology, receptor status, stage at diagnosis, etc.
- Patient markers: age at illness, family history, etc.
- Tumor therapy: type and time of medical interventions, intensity of therapy, etc.
The idea of the prognostic relevance of patient competence is related to the concept of self-efficacy expectation. Albert Bandura has pointed out numerous connections between self-efficacy and other factors:
- Increased stress and decreased social support lead to lower self-efficacy expectations.
- The belief in self-efficacy has an impact on how people deal with stress and disappointment in pursuing their goals in life, and has far-reaching influence on motivational processes.
- Individuals with a high expectation of self-efficacy show greater exertion, endurance, and achievement than those with lower expectations .
- Individuals with high expectations of self-efficacy tackle tasks in a better mood (e.g. with less anxiety and depression ).
- Individuals with high expectations of self-efficacy are better able to cope with stress and disappointment.
- People develop more confidence in their self-efficacy, the more success they can actually achieve with their own behavior.
How patient competence and empowerment affect the body's own defense processes has not yet been clarified. If one understands the body's own defense processes in diseases as a construct of a complex interweaving of social, psychological, neurological , endocrine and immunological factors, then neurosomatics understands the brain as the most essential control center from which even epigenetic influences emanate.
Although there are numerous clinical studies that show that patient competence, self-empowerment, stress reduction and self-efficacy beliefs have a positive effect on the course of cancer, the prognostic relevance of patient competence is still controversial to this day.
Empowerment advice and resource scouting
The question of what can I do for myself and with my resources in a particularly critical life situation is in itself clear and understandable. The answer to this question, however, assumes a resource awareness. However, many people in our society lack such resource awareness, although they obviously have such resources; They then need a competence advisor who helps them to become aware of their own potential for crisis management. This is the goal of empowerment counseling.
The empowerment counseling is not - as in the usual medical briefing - about conveying medical facts. Rather, it is about helping the patient to develop a form of self-confidence to become aware of their own potential for self-help in mastering a critical life situation. The counseling technique for tracing the patient's resources is also known as resource scouting (scouting derived from the English word scout, pathfinder).
Web links
- C. Kranich: Patient competence What do patients need to know and be able to do? Federal Health Gazette 2004
See also
Individual evidence
- ↑ a b c Bopp A et al .: What can I do for myself? Patient competence in modern medicine. Rüffer & Rub, Zurich 2005.
- ^ Scheibler F: Shared decision-making. From compliance to decision-making based on partnership. Hans Huber Publishing House, Bern 2004.
- ^ Nagel G .; Heckl U .: Advice for cancer patients in the pharmacy. In: DAZ 33 39 - 44 (2001).
- ↑ Dept. Health: The expert patient. A new approach to chronic disease management for the 21st Century. DOH, London (2001).
- ↑ a b c d e Nagel G., Schreiber D .: Empowerment of women with breast cancer. Guide to resource-oriented breast cancer advice for physicians, nurses and other health professionals. Patient Competence Foundation, Zurich 2013: www.patientenkompetenz.ch.
- ↑ a b Weis J & Giesler JM: Patient Competency: A New Concept in Oncology. In: Joint decision in cancer therapy. Doctor and patient in the conflict area of shared decision. Bartsch HH, Weis J (eds): 132-140, Karger, Basel (2004).
- ↑ Kranich C: patient competence. What do patients need to know and be able to do. In: Bundesgesundheitsblatt 10: 950-956 (2004).
- ↑ Giesler J, Weis J: Patient Competency in the Oncological Context: Conceptual Basics and Measurement. In: Koch U & Weis J: Jahrbuch Med Psychol 22 158 - 170, Hogreve Göttingen (2009).
- ↑ Angenendt G et al. (eds): Practice of psycho-oncology. Psychoeducation, counseling and therapy. Hippocrates, Stuttgart (2007).
- ↑ a b Bandura A & Cervone D: Self-evaluative and self-efficacy mechanisms of governing the motivational effects of goal systems. In Higgins TE & Kruglanski AW (eds.): Motivational science: Social and personality perspectives .: Psychology Press, Philadelphia (2000).
- ↑ a b Custers R & Aarts H: Positive affect as implicit motivator: on the nonconscious operation of behavioral goals. Journal of Personality and Social Psychology, 89 (2): 129-142 (2005).
- ↑ a b Grawe K: Neuropsychotherapy. Hogreve Göttingen (2004).
- ^ A b Grossmann P et al .: Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research 57: 35-43 (2004).
- ↑ Lazarus RS: Fifty years of the research and theory of RS Lazarus., Erlbaum, Mahwah (1998).
- ↑ Moorey S & Greer S: Oxford Guide to CBT for People with Cancer. Oxford Guides to Cognitive Behavioral Therapy, Northamptonshire (2012).
- ^ Antonovsky A & Franke A: Salutogenesis. To demystify health. dgvt-Verlag, Tübingen (1997).
- ↑ Schmoll HJ et al. Ed .: Compendium of Internal Oncology, Springer Berlin (2005).
- ↑ Hüther G et al .: Mental stress and neural plasticity: An extended model of the stress-reaction process as a basis for understanding central nervous adjustment processes. Zsch psychosom Med 42: 102-127 (1996).
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- ↑ Andersen BL et al .: Psychological Intervention improves survival for breast cancer patients. A randomized clinical trial. Cancer , 113 (12): 3450-3458 (2008).
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- ↑ Buddeberg C et al .: Coping strategies and course of disease of breast cancer patients. Psychother Psychosom 55: 151-157 (1991).
- ↑ Falagas ME et al .: The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Res 9 (4): R44 (2007).
- ↑ Faller H: Do psychological factors influence the course of cancer? Z Med Psychol 13: 99-108 (2004).
- ^ Faller H: Success of psychological interventions. A review. In: Koch U & Weis J (eds): Psycho-oncology. Yearbook of Medical Psychology 22. Göttingen: Hogrefe: 189-198 (2009).
- ↑ Groenvold M et al .: Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat 105: 209-219 (2007).
- ^ Levy SM et al .: Immunological and psychosocial predictors of disease recurrence in patients with early-stage breast cancer. Beh Med: 67-75 (1991).
- ↑ Spiegel et al .: Effect of psychosocial treatment on survival of patients with metastatic breast cancer. The Lancet : 888-891 (1989).
- ↑ Schaeffer D & Schmidt-Kaehler S (eds): Textbook patient advice. Huber, Bern (2006).