The Effects of

Autonomy
on Empowerment
Raquel McCarthy
GNRS 507: Scientific Writing
August 1, 2016

Background
Elderly with cancer patients face increased
barriers to exercising autonomy

50% of cancer diagnoses in adults over 65

Empowerment is a measure of intervention efficacy
Patients with chronic diseases face autonomy
problems

Problem: geriatric patients face feel capacity to make

autonomous decisions is not honored, empowerment
not promoted

IOM (2014) recommends palliative care proficiency for

all clinicians
IOM, 2014; De la Cruz & Bruera, 2013

PICOT
Does implementing autonomy-supportive palliative care
education versus no autonomy-supportive palliative care
education, increase empowerment as measured by the
Patient Empowerment Scale (PES) for geriatric, oncology
patients over 3 months?

Population: Elderly, oncology patients ( > 65 years)

Intervention: Palliative care education using
autonomy support

Comparison: Receives intervention vs no intervention

Outcome:

Increase empowerment

Timeframe: Over 3 months

Literature Review
All researchers sought to manipulate or expand upon
empowerment

Heavy emphasis on long-term diseases

Sampling:
Age was broad and ill-defined
Homogenous participant pools
Drew from various contexts

Key domains studied:

Self-efficacy
Disease knowledge
Patient-provider communication
Self-determination

Evidence Quality
Qualitative approaches relied upon
Nurse perspectives or patient experiences evaluated
Surveys (n=197, n=393)
Semi-structured interviews (n= < 20)
Questionnaires (n=76)

Evidence grading:
Level I
Level V
Level VI

Small sample sizes = richer data

Category saturation
Lindberg et al., 2015; Sandelowski, 2007; Stillwell et al., 2010

Key Findings
Little agreement on empowerments definition
Standard, validated measure necessary

Autonomy = control, patients making decisions

Empowerment-based interventions were shown to
improve patient outcomes

Nurse-patient relationship important

Empowerment consists of 3 dimensions:
Self-efficacy
Knowledge
Shared decision-making

Clinical Findings
Nurses are more effective educators
Timing of intervention is key
Palliative care for health promotion
Family caregivers desire participatory
role

Autonomy problems are not always present

Autonomy problems are often greater than
pain/physical burdens

Three dimensions must be incorporated:

knowledge, self-efficacy, decision-making
Smith et al., 2012

Change in Practice
UCSD Moores
Cancer Center

Improved
Program

Nurse-led

Physician-led

PAQ screening

No autonomy assessment

Focus: Autonomy

Focus: Pain management

problems

Patient-centered

Family integration

Initiated at any point in

Initiated early, alongside

disease course

standard treatment

3 dimensions absent

Incorporate 3 dimensions

Goal: Comfort

Goal: Increase
empowerment
UCSD, 2016

Potential Barriers
Physician preference by patient
Physician/organization opposition to change
Autonomy problems may not be present
Lack of readiness to receive or provide new
information

Patients may desire different outcome/have

unique needs

Making changes takes time and

effort

Ethical, Cultural, &

Spiritual Considerations
Spiritual distress
Incorporation of spiritual beliefs
Respecting autonomy is key
Identify language, literacy barriers
Cultural competence
Western: Individual
Asian/Latin: Family-oriented, matriarchal
Arab: Patriarchal

Eye contact and touch

Beauchamp & Childress, 2013; Murray & McKinney, 2010

Outcome Measurement
Group 1: receives autonomy-supportive intervention
Group 2: receives standard PC from UCSD
Empowerment measured at 3 months
Patient Empowerment Scale (PES)
28-item Likert-type scale
Appraises empowerment, ability to make decisions
Four categories: 1 strongly disagree to 4 strongly
agree
10-15 minutes to complete
Non-upsetting, easy-to-answer questions
Bulsara et al., 2006

Conclusion
Empowerment-based interventions
Increase self-efficacy
Overcome autonomy problems

Universally agreed upon definition is needed

Three dimensions: self-efficacy, knowledge and
decision-making

Future research: establishment of a general

consensus on meaning of empowerment

Palliative care recognized as a means of

manipulating empowerment outcomes

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