• Open Access

Editorial

Authors


This issue includes a diverse set of articles that engage with patient decision making, satisfaction and patient-centred care. The implications of these study challenge not only practitioners and patients but also policy makers and health-care managers to consider how to develop services to support and enable care.

Krucien, Le Vaillant and Pelletier-Fleury[1] argue that organizational reforms need to be premised on a patient-centred model of health care. French service users involved in a Delphi process identified key aspects of their relationship with general practitioners including information sharing and the coordination of care but did not feel that neither the organizational form of the medical practice nor the demographic characteristics of the doctor were important. The second article also considers the importance of the physician–patient relationship.[2] Tofan, Bodolica and Spraggon discuss the results of a literature review and suggest that governance of the physician–patient relationship is premised either on trust or distrust. They conclude by setting out a conceptual framework that seeks to match physicians and patients on the basis of patients' preference for information and decision-making autonomy and physicians' communication and behavioural styles.

A different sphere where collaboration between patient and physicians is essential is patient education.[3] Stokken sets out the development of state supported patient education in Norway over the last 15 years stressing the needs and tensions associated with the plasticity that allows tailoring of provision to local circumstances. Seymour et al.[4] also explore an educational programme but it is one that adopts a peer education approach to advanced care planning. Using participatory action research, they report that those participants who were already had access to social capital by being embedded in their community were more successful.

Wilson, Lydon and Amir[5] explore the issue of choice in cancer services which in the UK is predominantly focused on the initial referral from primary to specialist care with far less attention to referral during follow-up care after treatment. For patients and carers, this emphasis is problematic. Respondents did not feel they were in a position to exercise choice when referred for investigation for possible cancer because of their lack of knowledge and emotional turmoil, and after treatment during follow-up care, many patients and carers felt there was almost no choice and a lack of consistency requiring them to actively manage the system. This has implications for the development of personalized patient-centred after-care treatment instead of the current approach to follow-up.

The issue of choice was also at the centre of Carroll et al.[6] study examining decision making by patients relating the implantation of a defibrillator. They argue that making the decision about an implantation device is different from treatment and set out a model to explain the factors that patients take into account and the variation in their response from active to passive although the majority wanted the doctor to make the decision.

The importance of different experiences for particular ethnic groups is raised by Newbigging, McKeown and French[7] in their article on the provision of mental health advocacy services for African and Caribbean men in England, Wales and Northern Ireland. They argue that the distinctive experience of this patient group means that advocacy is particularly important to improve access and the experience of care but has received little attention by researchers. The issue of stigma and the particular experience of a category of patients are also explored in the final article in the issue by Li et al.[8] who explore the relationship between medical care providers' attitudes towards patients living with HIV and patient satisfaction in county hospitals in China. They argue that stigma and the enactment of such sentiments within the medical provider–patient relationship is a central element of patient satisfaction at the hospital level. This has important implications for introducing stigma reduction interventions in health-care settings and also for considering those factors that shape patient satisfaction and challenge patient-centred care.

Taken together, these articles emphasize the importance of both common collective experiences of patients and the diversity of experience relating to ethnicity and points on the patient journey. They also challenge assumptions about the process of decision making and the desire by patients to make choices providing evidence that has implications for policy makers, practitioners and patients.