who can help me?

E M P I R I C A L S T U D I E S doi: 10.1111/j.1471-6712.2007.00579.x

What is important for patient centred care? A qualitative study about the perceptions of patients with cancer

Kirsti Kvåle RN, MSc1 and Margareth Bondevik RN, PhD2 1 Department of Post Graduate Studies, Betanien Diaconal University College, Fyllingsdalen, Norway,

2 Department of Public Health and

Primary Health Care, Section of Nursing Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway

Scand J. Caring Sci; 2008; 22; 582–589

What is important for patient centred care? A

qualitative study about the perceptions of patients

with cancer

Background: This article deals with one of the themes from

interviews in a larger qualitative study about cancer pa-

tients’ perceptions of good caring. It is widely recognized

today that patient centred care is important. Patients’ va-

lues and perceptions must be acknowledged in order to

make care evidence based and to meet the demands of

quality improvement processes.

Aim: The aim was to get insight in patients with cancers’

perceptions of the importance of being respected as part-

ners and share control of decisions about interventions and

management of their health problems and the reasons

behind their wishes.

Method: Giorgio’s scientific approach to phenomenology

was used. Twenty cancer inpatients with various cancer

diagnoses at different stages and with different prognoses

were interviewed. The sampling was purposive.

Ethical issues: Permission to carry out the research was

given by a Regional Committee of Research Ethics in

Western Norway and the data collection followed the

guidelines of the Data Inspectorate of Norway.

Main findings: The units of meaning identified could be

clustered into three themes with significance for patient

centred care from patients’ perspectives: (1) empowerment

(being respected, listened to, given honest information,

being valued); (2) shared decision making about the

treatment of the disease (discussing the treatment, but

letting the doctor decide in the end); and (3) partnership in

nursing care.

Conclusion: Health care professionals can practise patient

centred care by treating patients with respect, giving

honest information, making them feel valued as persons

and by inviting them to take part in all decisions about

their daily life and care. However, cancer patients’ desire to

make decisions about their treatments must not be taken

for granted. Doctors must find out the extent to which

each patient wants to participate and then give the

necessary information.

Keywords: empowerment, patient centred care,

partnership in nursing, decision-making about medical

treatment.

Submitted 1 October 2007, Accepted 6 November 2007

Introduction

Traditionally, patients have been placed in the role of

passive recipients of care delivered by healthcare experts

who know what is best for the patient (1). The ‘sick role’ as

described by Parsons (2) sees the patient as being exemp-

ted from his or her societal roles by a doctor, but the

patient only attains this privilege by submitting to the

doctor’s directives. Today, however, both healthcare pro-

fessionals and administrators clearly recognize that patient

centred care is important. Patients’ values and perceptions

must be acknowledged to make care evidence based and to

meet the demands of quality improvement processes (3).

Patient centred care is a widely used phrase, but the con-

cept is complex and not well defined (4). Lewin et al. (4)

suggest the following definition of patient centred care:

healthcare providers share control of consultations, deci-

sions about interventions or the management of health

problems with patients. Kitwood and Bredin (5) suggest

that patient centred practice can be achieved if practitio-

ners understand users’ needs and engage in positive work

with them. We also know that patients’ self-determination

can be impeded or enhanced by the professionals who care

for them (6). To become real partners in their own care,

patients need to be empowered. Empowerment can be

defined as a dynamic process where power is taken over,

Correspondence to:

Kirsti Kvåle, Department of Post Graduate Studies, Betanien

Diaconal University College, Vestlundsveien 19, 5145 Fyllingsdalen,

Norway.

E-mail: [email protected]

582 � 2008 The Authors. Journal compilation � 2008 Nordic College of Caring Science

given away and shared (7). Professionals can stimulate

patients’ empowerment by treating them with respect,

taking time to listen to them and making them feel valued

(8, 9). Studies have identified important aspects of good

care from the patient’s perspective. These include telling

them in understandable language what is important for

them to know about the disease and treatment, being

honest with them about their medical conditions, listening

to them, checking their perceptions before initiating action

and helping them in their thinking with regard to their

disease and treatment (10–12).

Information seems to be essential for patients to feel

empowered and gain control (13). Patients need to see

themselves as experts on their own lives if they are to

participate in decisions about their treatment and care.

Some patients, however, seem to derive security from the

‘healthcare worker knows best’ stance (14). In particular,

palliative care patients tend to adopt a passive role (15, 16).

Healthcare professionals often have complete power over

these patients, who may not have the physical resources to

exercise freedom of choice (17). The barriers to real part-

nerships in nursing have been described as time, tools and

training (18), but unfortunately sometimes healthcare

professionals regard informed patients as a challenge to

their power (8, 19, 20).

There are several studies about decision-making in

clinical medicine, but the evidence is mixed on the extent

of patients’ interest in taking part in decisions about their

treatment and care. Some patients have a strong desire for

information and involvement in making healthcare deci-

sions, but, more often, patients want to be informed about

their disease and their treatment while preferring that their

doctors make the decisions (1, 16, 21, 22). It has also been

found that patients are more likely than nonpatients to

prefer a passive role regarding treatment decisions. Physi-

cal changes, intensive medical interventions, emotional

distress and pain can influence their capacity to become

involved. Prescribing increased involvement for all patients

may be a form of paternalism in which healthy people

dictate what is best for patients (23), but patients can also

experience learned helplessness if met by a paternalistic

healthcare system (24). The lack of strong predictors for

the preferred decision-making role implies that clinicians

need to assess every patient individually to determine

which role he or she prefers (16, 21). Cahill (25) has stated

in a literature review that most of the research about pa-

tient participation has focused on the treatment of disease,

but gradually more researchers seem to be looking at the

concept of partnership in the context of care. It is, how-

ever, important to be aware that ‘patient participation’ is a

complex and multifaceted concept that has been defined

and operationalized in a variety of ways in nursing re-

search (25). A partnership can be defined as an interper-

sonal relationship between two or more people who work

together towards a mutually defined goal. In a partnership,

the nurse regards the patient as a fellow human being

(21, 26).

This article presents findings about one of the theme that

emerged from a larger qualitative study of cancer patients’

perceptions of good caring. Patients with cancer often face

difficult choices, including decisions about pain control,

treatment options, research participation and withdrawal

of treatment (6), while many treatment modalities can

have serious side effects and uncertain or limited benefits

(1). It is therefore important to find out if these patients

want to participate in decision-making about their treat-

ment and care. Although there are several quantitative

studies addressing this topic, there are few studies that use

qualitative designs to gain deeper insight into these pa-

tients’ perceptions. Qualitative in-depth interviews can

reveal not only whether patients want to participate in

decision-making about their treatment and care, but also

the reasons behind their wishes.

The study

Aim

The aim of this study was to get insight in patients’ with

cancer perceptions of the importance of being respected as

partners and share control of decisions about interventions

and management of their health problems, and the reasons

behind their wishes.

Method

Giorgi’s approach to phenomenology was chosen as the

research method (27). The aim of phenomenology is to

elucidate essential meanings of a phenomenon as the

informants experience it in their lifeworld. The researcher

aims to describe the phenomenon as accurately as possi-

ble, refraining from any preconceptions but remaining

true to the facts (bracketing past knowledge) (28). How-

ever, the formation of units of meaning and themes from

the data takes place as the researcher sees them (29). The

goal of phenomenology is to describe phenomena, not to

generate theories and models or to develop general

explanations (30). Giorgi has developed a scientific

approach to phenomenology inspired by Husserl’s (1913/

1983) philosophical phenomenological method which

encompasses three steps: (i) phenomenological reduction,

(ii) description and (iii) search for essences. Giorgi has

modified these steps. In his approach the descriptive step

becomes the first step and the search for essences will be

‘scientific’ essences dependent upon the unique perspec-

tive of the discipline and the context in which the

research is performed (31). Giorgi argues that when

phenomenology began as a philosophy, the guidelines of

scientific practice should be followed when doing

research in human science including caring. Confusion

� 2008 The Authors. Journal compilation � 2008 Nordic College of Caring Science

What is important for patient centred care? 583

sometimes arises when the researchers do not clarify their

understanding of phenomenology (32).

Informants

The informants were cancer patients in an oncology ward

in a regional hospital in Norway. Staff nurses selected the

informants according to certain inclusion criteria and the

guidelines of the Data Inspectorate of Norway. The inclu-

sion criteria were: age between 25 and 80, informed by the

doctor about the cancer diagnoses, admitted to the ward

for palliative or curative treatment and assessed by the

medical and nursing staff to be mentally and physically

able to take part in the research project. The sampling was

purposive and the criteria were patients with cancer in an

oncology ward admitted for treatment. Twenty patients

were interviewed, 10 women and 10 men (the gender

balance was not deliberate). Three more patients were

invited to participate in the study but refused. The reasons

are not known. Little new information was revealed in the

later interviews, and therefore no more patients were in-

cluded in the study (data saturation) (29). Most of the

patients were between the ages of 40 and 70. The patients

had various cancer diagnoses at different stages and had

different prognoses. Sixteen of the patients had metastases.

Most of the patients had been given life-prolonging and

symptom-relieving treatment, while for four there was the

possibility of cure. Twelve of the patients had been inpa-

tients in the ward earlier, and the patients had lived with

their cancer diagnoses for periods ranging from 3 months

to 6 years.

Interviews

The first author did all the interviews while the informants

were inpatients. The interviewer had experience in cancer

nursing from some years ago, but was now a lecturer in

cancer nursing in a nursing college and did not know the

patients beforehand. The theme for the interview was:

‘The importance of being treated with respect and having

the opportunity to take part in decision-making about

treatment and care as an aspect of good caring’. The

opening question was: ‘Do you feel that the nurses in the

ward are treating you with respect?’ The interviewer then

encouraged the patients to talk about the theme as freely

as possible and tried to make the interviews into dialogical

conversations rather than asking questions. The statements

made by patients to the interviewer about their experi-

ences and feelings led to new follow-up questions and

were important in shaping how the interviews proceeded.

Open-ended questions such as ‘Do you want to tell me

more about it?’ and ‘Can you tell me why?’ were used

when necessary to gain a deeper understanding of the

research question and meet the aims of the study (29).

Ethical considerations

The study was conducted according to the rules of the

Helsinki Declaration of 2002 (33). Permission to carry out

the research was given by the Western Norway Regional

Committee of Research Ethics, and the Director of the

Oncology Department. Data collection followed the

guidelines of the Data Inspectorate of Norway. The patients

gave written consent to participate in the study and to

allow tape recording of the interviews. The researcher as-

sured the participants by letter that the interviews would

be deleted after transcription.

Analysis

The interviews were transcribed in full and analysed

according to Giorgi’s (27) step-by-step approach to phe-

nomenology. Step 1: The transcribed interviews were

intensively read as a whole to gain a general under-

standing of what the patients expressed about the phe-

nomenon. Step 2: The interviews were re-read several

times and the text was condensed into units of meaning

(meaning discrimination). In this process, the researcher

needs an open attitude to let unexpected meanings

emerge (31). Step 3: The identified units of meaning were

clustered into themes of importance. With the help of free

imaginative variation one describes the essential structure

of the concrete lived experience from the perspective of

the discipline (31). Step 4: Checking the consistency be-

tween the identified themes and the general structure of

the interviews for a second time concluded the analysis

The quotations (translated from Norwegian) used to elu-

cidate the identified units of meaning are partly direct

quotations from single patients that describe the essence

of the patient’s meaning, and partly composite quotations

from many patients. There are no interpretations of the

units of meaning, only descriptions of how patients

experienced the phenomenon in their own world, formed

into themes by the researcher. The aim of phenomeno-

logical research was to understand the meaning of the

informants’ lifeworld; validity is determined by deciding

to what degree the researcher has been able to grasp this

meaning and therefore the findings were checked and

rechecked (29). Researchers are often advised to re-

interview informants (29) and obtain comments from

them about the researcher’s analysis as a part of valida-

tion, but Giorgi (27) does not recommend this. He argues

that it is the interviewer who is the researcher and not the

informant. In this study, we would have found it difficult

to re-interview the informants because of their life situ-

ation and the seriousness of their disease. Because of the

researchers’ experience in cancer nursing, she had to be

very much aware of her own preconceptions of the

phenomenon throughout the whole analysing process.

� 2008 The Authors. Journal compilation � 2008 Nordic College of Caring Science

584 K. Kvåle, M. Bondevik

Findings

The units of meanings identified in the interviews can be

clustered into the following significant themes for patient

centred care from patients’ perspectives: (i) empowerment

(being respected, listened to, given honest information and

being valued), (ii) shared decision-making about treatment

of the disease (being asked for their opinion, discussing the

treatment but letting the doctors decide) and (iii) part-

nership in nursing care (take part in all decisions about

daily life and care).

Empowerment (being respected, listened to, given honest

information and being valued)

All the patients stated that the nurses treated them with

respect. The patients emphasized this by using statements

such as: Absolutely they do, and that is not only my imagination

and: I have not met any nurse who has not shown me respect.

The interviewer then asked what the nurses said or did

that gave them the feeling of being treated with respect.

The following units of meaning were identified:

The nurses take me seriously and treat me as an adult

and are very good listeners. They encourage me to tell

them my wishes, listen to my questions and always

give me an answer. They also showed me respect as an

individual, not only as a patient, when they remem-

bered my name without looking at my papers when I

came back to the ward for treatment. The nurses

respect me when doing something extra to help me,

for instance finding something that is better for me to

eat when I tell them that I cannot have the food they

are giving me, rather than saying ‘Oh, well...’.

Many patients emphasized good information as an

important aspect of care and wanted the nurses and doc-

tors to be honest with them.

Honesty is important. I have told them ever since I got

ill that I do not want to be cheated. They must not tell

me one thing and do something else. If that happens, I

will be confused and insecure.

The nurses answer the best they can, and I ask many

questions. I want to know everything about myself,

about my disease and about my treatment. It is frus-

trating not to know all about your disease. If the

nurses cannot answer my questions, they tell me to

ask the doctors. They sometimes say: ‘Do you have a

note pad? Write your questions down so you don’t

forget.’ This is really good.

Shared decision-making about the treatment of the disease

The essence of the findings was that the patients wanted to

be informed, asked for their opinions, and be able to dis-

cuss the treatment of their disease with doctors, but

wanted the doctors to make decisions for them in the end.

The following quote illustrates the main reason why they

did not want to make the final decision themselves.

The doctors know better, but it is OK that they ask for

my opinion. I like to take part in the discussion, but it

is the doctor who decides. When one does not have

enough knowledge oneself, one has to accept that.

However, I would have sometimes liked to have more

information about the disease.

Some of the patients wanted to put all decisions in the

hands of the doctors. The reason for this is illustrated by

the following quote:

I do not wish to take part in decision making. The

doctors know what they are doing and what they do is

right. I have so much respect for their profession that I

do not believe that my decision will be better than

theirs. I trust them; at least I want to. I leave the

decision in their hands. They have not really asked

about my opinion, but I have no need of them doing

so either.

Only a couple of patients wanted to decide for themselves.

This is illustrated by the following quotes.

Yes, yes of course I want to decide about my treat-

ment. I belong to the so-called difficult group of pa-

tients. There are three types of patients: the ones that

have given up and say, ‘‘OK, this has happened to me.

It is fate’’; the group that believes the doctor is still

holy and knows everything and so follows his advice

fully; and the difficult ones like me who are asking

questions.

A patient with much pain expressed how important it was

for medical staff to take time to discuss treatment with the

patient:

The staff did not ask for my opinion the first six

months. It was a long time before my pain was taken

seriously. Why this was I don’t know. Maybe I was not

good enough at telling them, or I looked too healthy.

The patient needs to be secure before talking about

their needs. The nurses and doctors must have enough

time to sit down and find out what the patient’s needs

are. When the staff understood how bad it was, they

took it seriously. Now I get things the way I want.

Partnership in nursing care

Some of the patients expressed that they felt closer to the

nurses than the doctors and regarded the nurses more as

partners. The essence that emerged was that the patients

wanted to take part in all decisions about their daily life

and care. This can be seen as a wish for partnership in

nursing care. The following units of meanings were iden-

tified.

The nurses ask me to tell them my wishes and they do

what I want. This is very good. I want to take part in

decision making. When dressing my wound with

bandages and things like that, they ask if it is painful.

� 2008 The Authors. Journal compilation � 2008 Nordic College of Caring Science

What is important for patient centred care? 585

If I had not agreed with the way the nurses are doing

the dressing, they most certainly would have changed

it.

It was important for the patients to be able to influence the

decision about whom they had to share their room with,

but for different reasons. Two reasons are illustrated in the

following quotes:

I cannot stay in a dark room. I have to have the light

on, night and day, and I have to have fresh air and an

open door. I cannot be in the same room as patients

who want to turn off the light and have the door

closed. I told the nurses, and they tried to find patients

who were willing to share the room with me. They

never joked about it, and that was important because

it is very serious for me.

Sometimes the nurses put very ill people in together

with more healthy people in the same room. I have

suffered much because of this. Lately the nurses have

been cleverer by choosing patients that go together.

They also ask me how I want things in my room.

To be partners in the decision about how to administer

their treatment was also important. The following example

illustrates this.

They administrated the chemotherapy in a way that

enabled me to go home for some hours. They post-

poned the treatment for a couple of hours. That was

very good.

Discussion

The findings revealed that from the patient’s perspective,

being empowered, sharing decision-making about medical

treatment and having a partnership in nursing care are

important aspects of patient centred care. The patients

revealed by their examples, not only what was important,

but also why it was important and how it could be accom-

plished in practice.

Being empowered

The findings indicate that to be listened to, believed and

treated with respect as adults seemed to make the patients

feel valued, increased their self-worth and gave them a

sense of control. These aspects of care are identified in

other studies as being important for the patient’s process of

empowerment (9, 10, 34). It is somewhat concerning that

the patients, according to what they say, seem not to take

this for granted when they meet healthcare professionals

in a hospital. This is different to what is expected when

people meet elsewhere in society, and the finding suggests

that some patients still adopt the sick role when admitted

to hospital (2). It also indicates that a power imbalance still

exists between patients and healthcare professionals (35).

Healthcare professionals may consider these findings to be

minor aspects of care, but one of the patients clearly

expressed that not being listening to and believed can lead

to serious consequences. Her pain was not taken seriously

and she was suffering. Healthcare professionals still have

power over their patients’ lives (35). Another example

mentioned was being remembered by name when being

readmitted to the ward as a token of respect. Most of the

patients had stayed in the ward previously and to be

remembered by name probably made them feel valued as a

person and a friend, not only as one patient among many

others. We know that this can enhance the patient’s pro-

cess of empowerment (9, 34). The patients stressed the

importance of being given honest information, which is

confirmed in other studies (10), but this study also

revealed why it was important and how it could be

accomplished in practice. The patients did not want to be

cheated, frustrated and confused, and gave examples of

how the nurses helped them obtain the information they

wanted. By doing so, the nurses enhanced the patients’

process of empowerment (7).

Shared decision-making about the treatment of the disease

The patients’ process of empowerment can also be en-

hanced when healthcare professionals invite them to

share in decision-making (7). Shared decision-making

can be defined as a process by which patients and pro-

viders consider outcome probabilities and patients’ pref-

erences and reach a healthcare decision based on mutual

agreement (36). This study shows that patients’ attitudes

towards participation in decision-making about their

treatment were mixed. Most of the patients seemed to let

the doctor decide because it took the responsibility away

from them, and they trusted the doctor’s advice. This

confirms findings in other studies (21, 35, 37). Some

studies have found that patients with advanced disease

and older patients were reluctant to participate in deci-

sion-making about the treatment. One reason identified

was that they wanted to avoid negative information

about their prognosis. Some older patients may also have

had difficulty in understanding the consequences of the

decision and did not want to be responsible for the

outcome (16, 21, 38). Most of the patients in this study

had a life-threatening disease and were between the ages

of 40 and 70.

An essential finding was that some patients wanted to

get more information about their disease and that doctors

did not always ask for their opinion. Shared decision-

making is meaningless without sufficient information.

There are no data in this study about why doctors did not

give this information. Other studies however have re-

vealed that, in cancer care, doctors sometimes can be

reluctant to give the patients the information they need

about their prognosis. Giving information can also be very

time-consuming (39, 40). Patients’ age, social class and

education may also influence how actively doctors include

� 2008 The Authors. Journal compilation � 2008 Nordic College of Caring Science

586 K. Kvåle, M. Bondevik

them in decision-making. Patients from lower social classes

tend to receive a less participatory consulting style (41). A

couple of the patients interviewed in this study described

themselves as ‘difficult patients’ because they wanted to

decide their treatment themselves after gathering infor-

mation. It was not clear if the healthcare professionals had

given them the impression that they were being difficult,

or whether it was their own belief. These patients also had

the impression that they asked too many questions, and by

doing so they were challenging the doctors’ power.

Partnership in nursing care

When it came to decisions about their daily life on the

ward and their nursing care, the patients wanted to be

treated as partners. This confirms finding in other studies,

which have shown that patients often placed more

importance on everyday decisions than on decisions about

medical care (42, 43). The patients stressed the importance

of being told what the nurses did and why. This seemed to

give them a sense of control. Being able to go home be-

tween chemotherapy treatments meant a lot to a patient

and created only a little extra work for the nurses. Fortu-

nately, the nurses had enough knowledge and empathy to

not use their power to refuse (8, 17, 20). One of the pa-

tients spoke about her anxiety of being in a darkened room

and stated the importance of having the nurses listen to

her, take her seriously and not joke about it. It was sur-

prising, however, that this was not taken for granted.

Patient involvement has become more accepted in

nursing care (25, 35). There seems to be an understanding

that patients are experts on their own lives, and the role of

healthcare professionals is to provide information and

support (44). Some nurses are still unwilling to share their

decision-making powers with patients (35), but this study

indicates that many nurses treated them as partners (19,

26) and did not misuse their power. The literature de-

scribes patients and nurses working together towards a

mutual goal as a real partnership (19). If partnership in

care is to become a reality, both nurses and patients need

to perceive that they are respected autonomous individuals

with something to contribute (43). Nurses must reflect on

the power they have and try to create an atmosphere of

openness and honesty without any loss of professionalism.

Other studies have also shown that patients regard being

listened to, being provided with individualized relevant

information, being respected, and having freedom of

choice and the right to make decisions as important aspects

of good nursing care (45, 46).

The method’s strength and limitation

Undertaking qualitative interviews with people in a diffi-

cult life situation raises many ethical questions (47). Be-

cause of much experience in cancer nursing and interest in

the subject as a lecturer, the researcher had to be careful

not to change roles from interviewer to therapist by asking

sensitive questions that could be too awkward for the pa-

tients to answer (29). The interviewer considered it

unethical to start a process that she was not able to follow-

up since she left the ward right after the interview ended.

The interviewer also had to be aware of her own precon-

ceptions of the phenomenon and not ask leading questions

(48). Attention was given to the validity of the analysis

throughout the whole process, from the theoretical pre-

suppositions and forming the research question, through

designing interviewing, transcription analysing, validating

and reporting (29). This is important for the trustworthi-

ness of the study (49). The researcher’s competence and

experience (competence validity), dialogue with others

about the findings (communicative validity) and to what

extent can the findings lead to changes in practice (prag-

matic validity) (29) are also of importance. The transfer-

ability of the findings to another contexts must be judged

by the readers of the research, but to make this judgement

possible the researcher have given a detailed description of

this study’s research context and method (50). Patients’

perceptions of patient centred care can for instance vary

according to culture, and to investigate this question, fur-

ther research is needed in settings that are different to an

oncology ward in Norway. Patients’ perceptions of the

concept can also vary according to their socioeconomic

group, education, age and stage of disease (39, 41). In this

qualitative study, the findings cannot be analysed using

demographic variables, but they can contribute to the

development of hypotheses for quantitative studies inves-

tigating these research questions. Quantitative and

qualitative methods have complementary strengths and

limitations, and using both methods to answer a research

question can extend and validate the findings (51).

Conclusion

There are quite a few quantitative studies done about pa-

tient centred care, but not many studies using qualitative

methods. This study revealed not only what the patients

considered important for patient centred care, but also

why this was important and ways it can be accomplished

in practice. This is the strength of using a qualitative

method, and the findings may contribute to a deeper

understanding of the concept patient centred care.

The findings indicate that being listened to, believed and

treated with respect as adults seemed to make the patients

feel valued, increased their self-worth, and enhanced their

process of empowerment. The findings are mixed with

regard to decisions about treatment of the disease, but

most of the patients wanted to discuss their treatment

while allowing the doctor to decide because of their lack of

competence. This can be seen as shared decision-making.

The implications for practice drawn from the findings in

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What is important for patient centred care? 587

this study indicate that even in today’s well-informed

society it cannot be assumed that all patients want to

participate in decisions about the treatment of their dis-

ease. Doctors should take the time to find out from patients

the nature and extent of participation each desires, and

then give the information necessary to be a partner in care

regardless of patients’ age, education, social class and stage

of disease. This finding may also indicate that healthcare

professionals and people who are healthy stress the

importance of patient participation more than do those who

are ill. Physical changes, intensive medical interventions,

emotional distress and pain can influence patients’ capacity

to take part. All the patients, however, wanted to take part

in decisions about their daily life and care in the ward and

gave examples of why this was important and how it could

be done. Partnership in nursing can be practised by inviting

patients to be partners in all decisions that affect their daily

life and care. The examples given included decisions about

how to dress their wounds, administer their chemotherapy

and with whom they would share their rooms.

Acknowledgement

Kirsti Kvåle would like to thank her employer, Betanien

Diaconal University College, for making this study possible.

Author contributions

The first author Kirsti Kvåle did the study under supervi-

sion of the second author Margareth Bondevik. The second

author supervised the whole research process from the

designing of the study through the data collection and

analysis phase and in writing the paper. The first author

Kirsti Kvåle, did the interviews and analysed the data.

Funding

The authors would like to thank the Norwegian Cancer

Society and the Norwegian Society of Nurses (ref. no.

2003/00135) for financial support.

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