Patient engagement drives improved health care delivery and research

The practice of urology takes teamwork, with patients being valued members of the team. Still, patients often aren’t included in clinical discussions, treatment recommendations, research prioritization, or research design and conduct.

“It’s equivalent to developing a consumer product without factoring consumer needs into product development and marketing,” said Angela Smith, MD, director of urologic oncology at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina, during Saturday’s Journal of Urology® Lecture 2022: “Engaging Patients: A Challenge to Our Care Delivery and Research Priorities.” 

If you neglect consumer needs and feedback, the product isn’t apt to be a success. Medicine is similar. “We’ve been leaving the patient out for decades,” Dr. Smith said. “It’s no wonder over half of our clinical trials fail, due to issues such as lack of recruitment.”

Patient engagement combines interventions designed to increase patient activation—their knowledge, skills and willingness to manage their own health care—to promote positive patient behavior, such as obtaining preventive care or exercising regularly. Patient engagement is one strategy to achieve the triple aim of improved health outcomes, better patient care and lower costs. 

“Engaging patients is a challenge to our care delivery and research priorities, but it’s worthy of our time because it can lead to better outcomes and can reduce costs,” Dr. Smith said. “When patients are engaged in their own health care, they’re likely to use fewer services.”

How can you intentionally engage patients in your practice or institution? Dr. Smith offered these recommendations:

• Direct care: When providing patients with information about a diagnosis, ask them about their treatment plan preferences. With an engaged patient model, “treatment decisions are made based on medical evidence and your clinical judgment, but also on patients’ preferences,” Dr. Smith said.
• Organizational design and governance: Survey patients about their care experiences. Hospitals can involve patients as advisors or advisory council members. “Patients can co-lead hospital safety and quality improvement committees,” Dr. Smith said.
• Policy making: A public agency can conduct focus groups with patients to ask opinions about a health care issue. Use patients’ recommendations about research priorities to make funding decisions for allocating resources to health programs. “Have an actual patient on your committees that create policies,” Dr. Smith said.           

Intentional patient engagement also plays an important part in clinical research. “For urologists at the forefront of innovation, having studies that include the patient’s voice helps channel which intervention to create and practice,” Dr. Smith said.            

“You can learn patient engagement skills and it doesn’t take much effort,” she added. Start by routinely asking three questions: Did we engage patients in shared decision making? Do we involve patients when optimizing our clinical operations or developing policy? Are patients involved in guideline development and dissemination?