Editorial

This issue of the journal includes a themed section on Philosophy, health services and research edited by Vikki Entwistle and Alan Cribb ¹ that illustrates different ways that applied philosophy is salient to the way we think about health care, how it is practiced, conceptualised and framed in policy. It also includes the first Policy Digest ² focusing on the evolution and current proposed changes to the role of patients and the public in relation to health and social care in the United Kingdom. Particular attention is drawn to the policy divergences between the different countries – England, Northern Ireland, Scotland and Wales – within the United Kingdom.

This issue also contains a series of articles on research on decision making. Andrea Charise and a large and diverse interdisciplinary group of colleagues reinforce our understanding of the importance of context in patient decision making. ³ They develop and present a Bodies, Technologies, Place and Work (BTPW) Tool to aid researchers and policy makers to consider more holistically the potentially consequences of context on how decisions are made. The attitudes of specialist breast clinicians to decision aids to help patients choose between breast conservation and mastectomy are the subject of the contribution from Lisa Caldon and her colleagues. ⁴ Their analysis illustrates clinical defensiveness and resistance to patients being involved in decisions about their treatment as many do not accept that patients can be sufficiently informed or able to express a preference.

Exploring the views of dying patients with cancer in an Australian teaching hospital about their preferences around resuscitation and the appropriate roles of patients and physicians in this decision is the subject of Eliott and Olver’s article. ⁵ They conclude that there is diversity in the roles that patients wish to fill and very different views of the proper part played by physicians to arrive at a decision.

The contribution from Cotterell and colleagues also focuses on patients with cancer, but explores their views on the personal impact of being involved set within the context of the British National Health Service that requires health organisations to involve patients. ⁶ The desire to improve services was a central motivation for many patients but frustration at the lack of clarity about the aims and objectives of involvement activities and in the attitudes of some health professionals were also consequences of involvement and had implications for future participation.

The views of patients with colorectal symptoms on a screening questionnaire to predict cancer is the subject of Wendy Pugh and Alison Porter’s article. ⁷ While patients identified only minor issues with the content of the questionnaire, they were not always clear about its purpose. The article identifies clear benefits of involving patients in the development of screening tools and to consider their views in the application of such tools.

Taken as a whole, this issue considers the multiple roles that patients and the public fill in different clinical contexts in different countries around the world. The need to involve patients in decisions about their care, the approaches taken by health professionals to make decisions and the way services are organised are all highlighted. We are also reminded that policy as well as practice needs to take account of the views of citizens and service users and that while professionals and politicians may believe they know what the people want there is no replacement for actual participation.