The emergency patient's participation in medical decision-making

Abstract

Aims and objectives: The purpose of this research was to explore the medical decision-making processes of patients in emergency departments.

Background: Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients.

Design: This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan.

Methods: Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim.

Results: The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage.

Conclusions: The findings fill a gap in knowledge about the decision-making process among emergency patients.

Relevance to clinical practice: The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Keywords: bricolage; emergency nursing; grounded theory; patient participation in medical decision-making; transference.