Nature of decision-making in the terminally ill patient

The increasing emphasis on the consumer's choice in health care treatment has contributed to the growing trend for decision-making to be shared between the patient and the health care team. If responsibility is to be shared, then it is important that health professionals identify the degree to which patients wish to participate in the decision-making process, in order that they can assist patients to achieve this goal. The seven patient case studies in this pilot study explored terminally ill patients' perceptions of their own participation in the decision-making process. A simple strategy, through the use of picture cards, established patients' actual and preferred forms of decision-making. These cards were presented to the patients at various stages of their illnesses, which permitted a longitudinal analysis of the decision-making process. Patients initially stated that they did not want much input into the decision-making process. In this study, however, as patients became more knowledgeable about their conditions, they desired greater input into the decision-making process. These findings also revealed that, although there was consistency between patients' preferred and actual forms of decision-making when they were initially admitted to hospital, discrepancies became apparent during the later phases of their illness. This emphasises the need for communication between all parties involved in health care decisions.