Patient-centred Prevention among PAD Patients: How to ensure patient autonomy and still get patients to make the "right" lifestyle decisions?

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This paper discusses a central professional dilemma in patient-centred education: on one hand the concern for ensuring patients autonomy and right to make their own decisions regarding their treatment and, on the other hand, a concern for getting patients to make the “right” decisions that will improve their health condition.
The patient-centred approach (and related concepts: patient participation, involvement, and empowerment) is being promoted both in healthcare politics and by healthcare professionals as a way to achieve more active self-managing and self-caring patients. Patient-centredness is thus promoted as a way to organize health more effectively (in terms of cost and treatment outcomes) and as a way to ensure patients’ autonomy and fundamental right to make their own decisions regarding their treatment.
Critical voices within social and nursing theory have however argued that the patient-centred approach does not ensure patient autonomy, but continues to be organized according to biomedical regimes and thereby carry on a paternalistic approach.
In this paper, I present findings from a PhD project, which investigates how the ideal of patient-centredness is practiced in the case of a patient-centred prevention programme aimed at PAD patients, which includes medical treatment as well as individual nurse-led lifestyle-oriented conversations (inspired by psychological theory and methods such as Motivational Interviewing).
The findings are based on four months ethnographic field study at two vascular clinics in the period 2009-10 including ethnographic interviews with health professionals and patients.
The paper shows that the preventive programme’s patient-centred approach and ambition to ensure patient autonomy is challenged by patients involved in the programme. The paper shows that the programme’s attempt to facilitate that patients make their “own” decision is challenged by patients who understand the preventive programme in relational terms and even demand more intervention from the professionals in terms of expert advice, involvement, and discipline.
Based on patients’ own statements (made in clinical encounters and interviews), the paper discusses the concept of autonomy and challenge the critiques regarding paternalism that the patient-centred approach has faced. The paper argues that patient-centredness argues for an understanding of autonomy as a relational property/entity, which implies that professionals intervene in the development of patients’ autonomy by expanding their capacity to make and actualize choices. The dilemma regarding the concern to ensure patient autonomy and still wanting patients to make the “right” choices is not one to be solved, nor a matter of choosing one of the two; rather, when going with a relational understanding of autonomy, they are, as such, inter-related.
Original languageEnglish
Publication date2014
Publication statusPublished - 2014

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