Chapter Twelve
Empowering Women to Take Control
Heart disease in women claims more lives than all types of cancer combined. Each year more than 600,000 patients die of heart disease in the US, and many of these victims are female. While death rates in men are declining, mortality in women continues to rise or stay the nearly the same. A large number of female patients never even knew that they were at risk for cardiovascular disease. Few had ever been screened for heart disease and most were undiagnosed and untreated. Like many women, these victims thought that they were more likely to die of breast cancer than of heart disease. Many incorrectly believed that heart disease was a disease of men.
Unfortunately, the legacy of limited awareness of heart disease in women persists in the US and the UK today. Although great strides have been made over the last decade, women with heart disease remain undertreated and underserved. As we have seen in previous chapters, there are many reasons for the gender-related disparities in care — some biologic, some societal and others related to healthcare provider attitudes and preconceived notions. Fortunately, I believe that there are several potential solutions that will allow us to close this unacceptable gap in care going forward. Working with patients, specialists and primary care providers in a more cooperative fashion will allow for earlier identification, screening and treatment of women who are at risk. However, in order to be successful in achieving our goals of equality in cardiovascular care, we must also engage patients and their families. Through education and awareness campaigns and activities, we must empower women to take control of their own cardiovascular health. Empowering patients to assume individual responsibility for their own heart health most often results in improved outcomes. Patients who are empowered are more likely to educate others and advocate for improved care for both themselves and their friends and families.
In order to understand better how we can empower women to take reduce their own risk for cardiovascular disease and its negative health consequences, we must first understand better what empowerment is all about. The concept of empowerment can be quite complex. In general, empowerment can be defined as a multi-dimensional process that allows people to take better control over their lives. Empowerment involves addressing interrelated social, economic and psychological issues and must occur at multiple levels — individual, group and community. The process of empowerment is a journey and allows individuals to implement change in their own lives, the lives of others and in society as a whole. In order to be relevant and effect change, empowerment must resolve around an issue that a person deems to be of significant importance. Patient empowerment has become a top priority in many countries including the US and the UK. When healthcare professionals involve the patient in care and treatment decisions, the physicians become more responsive to patients’ needs and concerns and ultimately deliver better care. Moreover, patient compliance rates are increased when they are more closely involved in their own care plan.
What are some empowerment strategies for women?
Patient empowerment is a process designed to facilitate self-directed behavioral and lifestyle changes. Empowerment involves several steps. Much of the literature on empowerment of patients comes from diabetes education. For years, endocrinologists and diabetes educators have realized that blood sugar control and compliance is much improved through patient empowerment.1 In the literature, empowerment involves providing the self-awareness and knowledge required for patients to understand their disease or risk for disease and ultimately provide self-care in consultation with a medical professional. This type of empowerment engages patients to participate in their own disease management. In the case of diabetes, patients are first educated about their disease and on its day-to-day management. They are taught what to look out for and what types of signs and symptoms may signify a medical emergency. They are then educated on how to best care for their diabetes and how to respond to changes in blood sugar levels or other potential complications. Once the patient is fully educated, they begin the process of understanding the principles of self-care and learn how to manage their day-to-day activities in the setting of chronic disease (in this case, diabetes). Once comfortable with the routine management, patients begin to take control of their own diabetes care and learn to interact with their healthcare professional when necessary — in a team-based approach to care. Patient engagement and involvement in daily care between visits with healthcare providers has been shown to substantially improve blood sugar control and decrease diabetic-related complications. Similarly, women with heart disease or risk factors for disease can be empowered through the same process in a stepwise fashion — awareness, education, engagement and ultimately patient empowerment to effect change.
In the case of women with heart disease (or at risk for heart disease) the process of empowerment involves improving community awareness of the risks of heart disease to women. Women must be educated that they are at risk for disease and that they are more likely to die from heart disease than any other medical problem. In addition, women who do not have heart disease must be made aware of the risk factors for heart disease and how each individual woman can modify her risk. As mentioned in previous chapters, these important educational objectives can be handled through multiple venues — community seminars, internet sites and social media, as well as direct person-to-person contact. Once women have been informed of the facts surrounding heart disease and the risk factors associated with developing disease, they must be provided with goals and instructions as to how to modify risk. Once they have understood the problem, its risks and how to modify risk they become empowered to effect change. Through mass education and community-wide efforts, not only are those at risk empowered, but those who are not yet at risk are also educated and ready to assist others to modify lifestyle and limit risk for heart disease. As a society we must develop a culture of heart healthy living — the empowerment of women is critical to success in reducing death from heart disease in both the US and the UK. Ideally, we, as a society, create a “buzz” around our efforts to close the gender gap in care.
What steps can patients take to empower themselves?
Once we have empowered women to make changes in lifestyle and (hopefully) encourage others around them (including friends and family) to do the same, we must continue to engage patients in their own care. Women must begin to take control of their own healthcare. For instance, if a woman is seeing a provider that she does not connect with and does not feel partnered with, she must make a change. Traditionally, it is very difficult for patients (male or female) to “fire” their physician. However, it is critical that each individual female have a partner in care that they can work effectively with. Success in prevention of disease is dependent upon a close relationship with a healthcare provider in order to achieve common goals. Each patient must have find a physician or other healthcare provider with whom they are able to feel comfortable asking questions, debating treatments and “co-managing” disease. It is no longer acceptable for a patient to sit back and let the physician make all of the decisions for her — each patient must play an active and engaged role in care. Each patient must not only accept individual responsibility for her own care and disease management but must also advocate for herself and her family.
Physicians and other providers of healthcare to women must be open to discussion: we must be willing to listen more and dictate care less. It is vital that we take the time to understand the patient and their family. It is critical that we also understand what things are important to the patients and what they value most. Through a better understanding of each individual’s circumstances we may be better equipped to help guide them through their healthcare journey. Ultimately, physicians must move away from algorithmic approaches to care. We must certainly apply the guidelines and best practices to each case but we must bond with each patient and treat each individual in a way that best suits their particular risks, goals and needs.
Here are a few important tips to enhance productivity and success for patients and healthcare providers when preparing for an office visit:
1.Come prepared: Patients should have read about their disease and come with questions. Providers must be ready to answer and take the time required to make sure that they are meeting the needs of the patient and addressing the concerns, fears and uncertainties that each patient may bring to the visit.
2.Be accountable: Both physician and patient should have “action items” assigned at the office visit and be held accountable for reporting the results to one another at subsequent visits. For example — the physician may be responsible for checking a cholesterol level and reporting the findings and the patient may be responsible for attending an exercise program three times a week during the interval between visits. This type of shared responsibility can motivate and empower patients to improve their own cardiac health. They are engaged, informed and active participants.
3.Be ready to negotiate: Patients and physicians are not always going to agree. We must work to provide our female patients with an atmosphere in the clinic that promotes shared responsibility and negotiation. There are often multiple ways to approach a particular problem — it is important to choose the treatment that is acceptable to both doctor and patient — success rates will be improved.
Figure 12.1 Keys to successful navigation of a visit with a healthcare provider.
How will empowerment ultimately improve outcomes for women with heart disease?
I believe that empowerment of women is the most critical step in improving outcomes for women with heart disease. The empowerment of women will change the way in which physicians and other healthcare providers deliver care. Women with heart disease can set a healthy example for others who are yet to be diagnosed through effective secondary preventative efforts. Now, more than ever, women throughout the US and the UK are leaders in business, politics and education — by engaging these leaders in health promotion and individualizing healthcare for women we can change the course of heart disease and reduce cardiac-related morbidity and mortality over the next decade.
While we have certainly made improvements in cardiac care for women over the last decade, gender differences in care still remain. Through education, awareness and partnerships with engaged and empowered patients we can move closer towards equality in care and ultimately close the gap for the years to come.
1 Anderson, R. M., Funnell, M. M., Barr, P. A. et al. (1991). Learning to empower patients: results of professional education program for diabetes educators. Diabetes Care, Volume 14(7), 584–590.
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