Patient participation, decision-makers and information flow in surgical treatment

Aims and objectives To clarify patient participation by specifying three kinds of information flows between healthcare professionals and patients in four models such as the paternalistic, shared, informed and nonpaternalistic models. Background The relationship between healthcare professionals and patients has evolved from a traditional paternalistic model where 'doctors know best' and patients are passive recipients, to a partnership where patients act as active participants. Design A qualitative study. Methods Qualitative data from interviews with four doctors, seven nurses and seven patients illustrate these relationships. Results A 3x3 matrix is developed where healthcare professionals can make decisions unilaterally, patients can make decisions unilaterally, or these can make decisions jointly. Information can flow from healthcare professionals to patient, from patient to healthcare professionals or both ways. Conclusions This conceptualisation provides a rich understanding of decision-making and information flow in surgical hospitals. Relevance to clinical practice The paper illustrates how practice can be assessed empirically to determine how it fits into the structure. Strategies can be implemented to move practice from one part of the structure to another part.