Patient and Health Care Advocates
3-4 Minute Read
Author: Becky Jayakumar, PharmD, BCIDP, BCPA
Purpose
To elucidate the role, scope of practice, ethical considerations, and board certification for the patient advocate.
Learning Objectives
Identify the role of the patient advocate.
Recognize the scope of practice and ethical considerations of the patient advocate.
Describe the benefits of board certification for the patient advocate.
The healthcare system often is complicated and fragmented making it challenging to navigate for those without a background in medicine. “Only 12% of U.S. adults have the health literacy skills needed to manage the demands of our complex health system, and even these individuals’ ability to absorb and use health information can be compromised by stress or illness,” the Agency for HealthCare Research and Quality (AHRQ) reports.(1) The field of professional patient advocacy emerged in response to these many challenges.
Role and Core Functions
Most physicians are likely well-versed in working with informal personal advocates who are frequently family, friends, or caregivers of a patient. The Joint Commission contends that “[e]veryone getting medical treatment should have someone to support them, to help raise questions, take notes, enhance communication with medical staff and make sure they are receiving patient-centered care.”(2) Professional patient advocates perform much of the same function as the informal personal advocates who patients bring to their medical appointments; professional patient advocates assist, support, and guide patients in the navigation of the complex health care system.(3) Ultimately, the professional patient advocate works directly with their client or the clients’ legal representative to clearly communicate complex health information and promote informed decision making. They provide guidance and assistance to the client, who is making their own decisions related to their health needs. Frequently, a patient advocate serves as the liaison between patients, healthcare staff, and/or insurance companies.(2,3,4)
Scope of Practice & Ethical Considerations
Prior to the written service agreement to consult, the professional patient advocate develops and discusses clear client expectations which relates to their scope of practice including their areas of proficiency and expertise. If the client needs assistance in an area where the patient advocate does not have expertise, the patient advocate is obligated to refer the client to the most appropriate system, resource, or alternative professional.(4)
At no time does the patient advocate make decisions about specific treatment choices, provide clinical options, or perform any type of medical care, even if they possess additional clinical credentials that would allow them to. If needed, the patient may have a healthcare proxy who can make healthcare decisions if the patient is unable to do so for themselves, whereas the advocate is a helper in the process. The patient advocate honors the clients’ personal values and promotes autonomy in the decision-making process. Additionally, the patient advocate respects the privacy of the client and abides by relevant laws and regulations as they pertain to confidentiality of all records and personal identifiable information. (3,4)
Board Certification
While board certification is not required to function as a patient advocate, the voluntary certification establishes the individual meets current competence and professionalism in the specialized area of patient advocacy.(3) Preparation for the board certified patient advocate (BCPA) certification exam can occur via self-study or through a number of universities or organizations. To qualify to sit for the exam, the individual must provide two letters of recommendation and possess a bachelor’s degree or equivalent experience. As with most healthcare professionals, continuing education (30 total hours with six hours in ethics and three hours in justice, equity, diversity, and inclusion every three years) must be completed to maintain their certification.(3)
Considerations
As physicians seek to provide patient-centered care, working collaboratively with patient advocates can be helpful for improving communication, trust, patient engagement, and, ultimately, patient outcomes.(5) As you consider ways to collaborate with professional patient advocates consider the following:
Patient advocates can be particularly helpful in elucidating the patient’s values and preferences which is an essential component of shared decision-making.(6)
Patient advocates can save you time by helping overwhelmed patients prepare for their medical appointments by writing down their questions and concerns, so you don’t get the dreaded doorknob complaint.(7)
Patient advocates tend to increase patient satisfaction, outcomes, and may even reduce medical errors.(8)
Patient advocates assist patient-centered care by improving patient engagement and self-empowerment throughout their medical journey.(9)
You and the patient advocate likely have the same goal – the best outcomes for the patient.■
References
1. Agency for Healthcare Research and Quality. AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition. Published September 2020. Accessed October 5, 2023. https://www.ahrq.gov/health-literacy/improve/precautions/index.html
2. The Joint Commission. Use an Advocate or Be an Advocate for Others: Advocates can help you be more active in your care. Accessed October 5, 2023. https://www.jointcommission.org/resources/for-consumers/take-charge/use-an-advocate-or-be-an-advocate-for-others/#:~:text=Everyone%20getting%20medical%20treatment%20should,is%20called%20a%20patient%20advocate.
3. Patient Advocate Certification Board. BCPA Study Guide. Jan 4, 2021; 1 – 40. https://www.pacboard.org/wp-content/uploads/20210115Candidate-Study-Guide-Published.pdf
4. Patient Advocate Certification Board. Competencies and Best Practice required for a Board Certified Patient Advocate (BCPA). October 2017;2-7. https://pacboard.org/wp-content/uploads/PACB-Competencies-final-10.10.17.pdf
5. Sarah Daren. How Healthcare Advocacy is Helping Improve Patient Care and Outcomes. Resources to Recover. Published September 18, 2022. Accessed October 5, 2023. https://www.rtor.org/2022/09/19/how-healthcare-advocacy-is-helping-improve-patient-care-and-outcomes/
6. Agency for Healthcare Research and Quality. The SHARE Approach: A Model for Shared Decisionmaking - Fact Sheet. Content last reviewed September 2020. https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tools/factsheet.html
7. Wittink MN, Walsh P, Yilmaz S, et al. Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors?. Patient Educ Couns. 2018;101(2):214-220. doi:10.1016/j.pec.2017.08.004
8. Abbasinia M, Ahmadi F, Kazemnejad. Patient Advocacy in nursing: A concept analysis. Nursing Ethics. 2019;27(1): 141-51. doi:10.1177/0969733019832950
9. John Hopkins Medicine. The Power of a Health Care Advocate. Accessed October 5, 2023. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-power-of-a-health-care-advocate