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


Shih, P and Rapport, F and Hogden, A and Bierbaum, M and Hsu, J and Boyages, J and Braithwaite, J, Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients' capacity for decision-making, Bmc Health Services Research, 18 pp. 1-10. ISSN 1472-6963 (2018) [Refereed Article]


Copyright Statement

Copyright 2018 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

DOI: doi:10.1186/s12913-018-3622-8


Background: A relational approach to autonomy refers to the way in which social conditions and relationships shape a personís self-identity and capacity in decision-making. This article provides an empirical account of how treatment choices for women undergoing breast diseases care are fostered within the dynamics of their relationships with clinicians, family members, and other aspects of their social environment.

Methods: This qualitative study recruited ten women undergoing treatment at a breast programme, and eight clinicians supporting their care, in a private teaching hospital in New South Wales, Australia. Fourteen patient-clinician consultation observations and 17 semi-structured interviews were conducted. Schema analysis of interview transcripts were undertaken by a team of researchers and corroborated by observational fieldnotes.

Results: Relational identities of patients influenced the rationale for treatment decision-making. Patients drew on supportive resources from family and medical advice from clinicians to progress with treatment goals. While clinicians held much social power over patients as the medical experts, patients highlighted the need for clinicians to earn their trust through demonstrated professionalism. Information exchange created a communicative space for clinicians and patients to negotiate shared values, promoting greater patient ownership of treatment decisions. As treatment progressed, patientsí personal experiences of illness and treatment became a source of self-reflection, with a transformative impact on self-confidence and assertiveness.

Conclusion: Patientsí confidence and self-trust can be fostered by opportunities for communicative engagement and self-reflection over the course of treatment in breast disease, and better integration of their self-identity and social values in treatment decisions.

Item Details

Item Type:Refereed Article
Keywords:Autonomy, decision-making, person-centred care
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Hogden, A (Dr Anne Hogden)
ID Code:137201
Year Published:2018
Web of Science® Times Cited:6
Deposited By:Australian Institute of Health Service Management
Deposited On:2020-02-05
Last Modified:2020-04-22
Downloads:2 View Download Statistics

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