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Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

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Shih, P, Rapport, F, Hogden, A ORCID: 0000-0002-4317-7960, Bierbaum, M, Hsu, J, Boyages, J and Braithwaite, J 2018 , 'Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making' , Bmc Health Services Research, vol. 18 , pp. 1-10 , doi: 10.1186/s12913-018-3622-8.

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Abstract

Background: A relational approach to autonomy refers to the way in which social conditions and relationships shape aperson’s self-identity and capacity in decision-making. This article provides an empirical account of how treatment choicesfor women undergoing breast diseases care are fostered within the dynamics of their relationships with clinicians, familymembers, and other aspects of their social environment.Methods: This qualitative study recruited ten women undergoing treatment at a breast programme, and eight clinicianssupporting their care, in a private teaching hospital in New South Wales, Australia. Fourteen patient-clinician consultationobservations and 17 semi-structured interviews were conducted. Schema analysis of interview transcripts wereundertaken by a team of researchers and corroborated by observational fieldnotes.Results: Relational identities of patients influenced the rationale for treatment decision-making. Patients drew onsupportive resources from family and medical advice from clinicians to progress with treatment goals. While cliniciansheld much social power over patients as the medical experts, patients highlighted the need for clinicians to earn theirtrust through demonstrated professionalism. Information exchange created a communicative space for clinicians andpatients to negotiate shared values, promoting greater patient ownership of treatment decisions. As treatmentprogressed, patients’ personal experiences of illness and treatment became a source of self-reflection, with atransformative impact on self-confidence and assertiveness.Conclusion: Patients’ confidence and self-trust can be fostered by opportunities for communicative engagement andself-reflection over the course of treatment in breast disease, and better integration of their self-identity and social valuesin treatment decisions.

Item Type: Article
Authors/Creators:Shih, P and Rapport, F and Hogden, A and Bierbaum, M and Hsu, J and Boyages, J and Braithwaite, J
Keywords: Autonomy, decision-making, person-centred care
Journal or Publication Title: Bmc Health Services Research
Publisher: Biomed Central Ltd
ISSN: 1472-6963
DOI / ID Number: 10.1186/s12913-018-3622-8
Copyright Information:

Copyright 2018 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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