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The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives

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  • Mendick, Nicola
  • Young, Bridget
  • Holcombe, Christopher
  • Salmon, Peter

Abstract

Doctors are widely encouraged to share decision-making with patients. However, the assumption that responsibility for decisions is an objective quantity that can be apportioned between doctors and patients is problematic. We studied treatment decisions from three perspectives simultaneously - observing consultations and exploring patients' and doctors' perspectives on these - to understand how decision-making that we observed related to participants' subjective experience of responsibility. We audio-recorded post-operative consultations in which 20 patients who had undergone initial surgery for breast cancer discussed further treatment with one of eight surgeons in a general hospital serving a socioeconomically diverse urban population in England. We separately interviewed each patient and their surgeon within seven days of consultation to explore their perspectives on decisions that had been made. Qualitative analysis distinguished procedurally different types of decision-making and explored surgeons' and patients' perspectives on each. Surgeons made most decisions for patients, and only explicitly offered choices where treatment options were clinically equivocal. Procedurally, therefore, shared decision-making was absent and surgeons might be regarded as having neglected patients' autonomy. Nevertheless, patients generally felt ownership of decisions that surgeons made for them because surgeons provided justifying reasons and because patients knew that they could refuse. Conversely, faced with choice, patients generally lacked trust in their own decisions and usually sought surgeons' guidance. Therefore, from the perspective of ethical frameworks that conceptualise patient autonomy as relational and subjective, the surgeons were protecting patient autonomy. Studying subjective as well as procedural elements of decision-making can provide a broader perspective from which to evaluate practitioners' decision-making behaviour.

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  • Mendick, Nicola & Young, Bridget & Holcombe, Christopher & Salmon, Peter, 2010. "The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives," Social Science & Medicine, Elsevier, vol. 70(12), pages 1904-1911, June.
    • Handle: RePEc:eee:socmed:v:70:y:2010:i:12:p:1904-1911
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    1. van Kleffens, Titia & van Baarsen, Berna & van Leeuwen, Evert, 2004. "The medical practice of patient autonomy and cancer treatment refusals: a patients' and physicians' perspective," Social Science & Medicine, Elsevier, vol. 58(11), pages 2325-2336, June.
    2. Simon N. Whitney & Margaret Holmes-Rovner & Howard Brody & Carl Schneider & Laurence B. McCullough & Robert J. Volk & Amy L. McGuire, 2008. "Beyond Shared Decision Making: An Expanded Typology of Medical Decisions," Medical Decision Making, , vol. 28(5), pages 699-705, September.
    3. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    4. Salmon, Peter & Hall, George M, 2003. "Patient empowerment and control: a psychological discourse in the service of medicine," Social Science & Medicine, Elsevier, vol. 57(10), pages 1969-1980, November.
    5. Karnieli-Miller, Orit & Eisikovits, Zvi, 2009. "Physician as partner or salesman? Shared decision-making in real-time encounters," Social Science & Medicine, Elsevier, vol. 69(1), pages 1-8, July.
    6. Entwistle, Vikki A. & Skea, Zoë C. & O'Donnell, Máire T., 2001. "Decisions about treatment: interpretations of two measures of control by women having a hysterectomy," Social Science & Medicine, Elsevier, vol. 53(6), pages 721-732, September.
    7. Mead, Nicola & Bower, Peter & Hann, Mark, 2002. "The impact of general practitioners' patient-centredness on patients' post-consultation satisfaction and enablement," Social Science & Medicine, Elsevier, vol. 55(2), pages 283-299, July.
    8. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
    9. Thompson, Andrew G.H., 2007. "The meaning of patient involvement and participation in health care consultations: A taxonomy," Social Science & Medicine, Elsevier, vol. 64(6), pages 1297-1310, March.
    10. Entwistle, Vikki & Williams, Brian & Skea, Zoe & MacLennan, Graeme & Bhattacharya, Siladitya, 2006. "Which surgical decisions should patients participate in and how? Reflections on women's recollections of discussions about variants of hysterectomy," Social Science & Medicine, Elsevier, vol. 62(2), pages 499-509, January.
    11. Wirtz, Veronika & Cribb, Alan & Barber, Nick, 2006. "Patient-doctor decision-making about treatment within the consultation--A critical analysis of models," Social Science & Medicine, Elsevier, vol. 62(1), pages 116-124, January.
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    Cited by:

    1. Stephen L Brown & Demian Whiting & Hannah G Fielden & Pooja Saini & Helen Beesley & Christopher Holcombe & Susan Holcombe & Lyn Greenhalgh & Louise Fairburn & Peter Salmon, 2017. "Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-13, May.
    2. Sinding, Christina & Hudak, Pamela & Wiernikowski, Jennifer & Aronson, Jane & Miller, Pat & Gould, Judy & Fitzpatrick-Lewis, Donna, 2010. ""I like to be an informed person but..." negotiating responsibility for treatment decisions in cancer care," Social Science & Medicine, Elsevier, vol. 71(6), pages 1094-1101, September.

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