Involving clients in decision making: breast care nursing

Abstract

The importance of involving patients in decisions concerning care and treatment is now acknowledged through policy, public and professional initiatives. NHS reforms have sought to offer choice in health care services through the development of an internal market. Public pressure groups such as the UK National Breast Cancer Coalition stress the importance of service users playing a full role in decisions about relevant issues (Air 1996). Professional recognition of the ethical importance of autonomy and self- determination has been reinforced by legal attention to the importance of informed consent (Sutherland et al. 1989). In Sidaway v Governors of the Royal Bethlem Hospital and others, 1984, the House of Lords rejected Mrs Sidaway’s claim of negligence for failure to warn of a 1 per cent risk of damage to her spinal cord, but encouraged doctors to give serious consideration to patients’ information needs and to doctors’ professional duty to inform (Brahams 1985). The nursing profession, through the UKCC Guidelines for Professional Practice (1996), now recognises the importance of adequate information in gaining clients’ consent. The Guidelines for Professional Practice section on client advocacy and autonomy acknowledge the importance of recognising a patient’s or client’s right to choose, respecting the choices made and the right to take part in decisions about care (UKCC 1996: 13–14).