Patient empowerment in the clinical encounter and beyond

In their paper Taking charge of your health: enabling patient empowerment in cardiovascular care, Acuña Mora et al. 1 present an overview of the main challenges encountered by healthcare providers in relation to the valuable goal of empowering patients to take care of their health.The authors start by acknowledging an ambiguity often related to the term patient empowerment (PE), as this may be understood as either a process or an outcome, or both, with possibly different implications for the patient-provider relationship.By referring to Small et al., 2 who defined PE as 'an enabling process or outcome arising from communication with the healthcare professional and a mutual sharing of resources over information relating to illness, which enhances the patients' feelings of control, self-efficacy, coping abilities and ability to achieve change over their condition', Acuña Mora et al. 1 point to the importance of collaboration, which is a key condition of an empowering patient-provider relationship.The authors then present valuable strategies to enhance the healthcare providers' capacity to successfully engage in such an empowering relationship.The strategies presented include (i) the practice of motivational interviewing to support the patients' self-determination and selfefficacy towards health-related goals; (ii) the use of narratives as part of patient-centred care; (iii) the delivery of patient education to facilitate active learning; (iv) the use of health apps designed to support selfmanagement; and (v) the promotion of peer support and networking.All of these strategies are evidence-based, may be enacted in the clinical encounter, and are congruent with the above-cited definition of PE.Taken together, they are likely to support the patients' motivation and skills to take care of their condition, hence their empowerment.In addition to all of the valuable strategies recommended by Acuña Mora et al., 1 it might be worth pointing to two additional types of interventions that healthcare providers might want to consider when aiming to support PE: one is emotion regulation and stress reduction to support psychological safety, as well as adjustment to illness, 3,4 and the second is personalized 5 and goal-oriented 6 healthcare planning to support self-regulation of agreed health behaviours. 7oing back to the duality of PE as both a process and an outcome, I would like to point to what seems to me a fundamental misunderstanding related to PE, either as a process or an outcome.Indeed, prevalent