Using Focus Groups to Evaluate the Patient's Involvement in Decision-Making: Associated with Their Vascular Access Device

T he traditional paternalistic model of medical decisionmaking, in which doctors make decisions on behalf of their patients, increasingly has come to be outdated.' Patient-centered care, patient-focused care or client-centered care describes professional health care interventions targeted at addressing the patient's needs.' Cox3.' proposed the Interaction Model of Client Health Behavior (IMCHB), which proposed that consumers of heald1 care have d1e need to be competent and self-determining in their health outcomes. This model also proposed d1at consumers of health care should be allowed d1e maximal opportunity to choose between intervention alternatives and health behaviors. This model was based upon information sharing and collaboration between the provider of health care and the consumer. Recently, health care practitioners have tried to promote patient autonomy and palticipation in clinical decision-making. This trend is based on the assumption that patient palticipation in decisions has been associated with improved patient outcomes. A model of shared decision-making is based upon the assumption d1at the patient is willing to take part in the decision-making process. A study by Mansell et at. demonstrated that although patients want their physicians to be involved in d1e decisions, almost all patients want at least some personal involvement in decisionmaking for major interventions.; However, other studies show that patients prefer that physicians have most of the control over decisions.6-10 In one study, a focus group methodology was used to determine the cancer patient's point of view concerning palticipation in decision-making." The results indicated that active participation of patients in care decision-making requires an environment that encourages patients to participate in their care. Also this study noted that much more attention has to be given to cancer patient participation in decision-making." Previous studies have demonstrated that the majority of cancer patients fail to achieve their desired level of participation during treatment decision-making." Purpose