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Aim: To review the evidence of the existing literature on the impact of guided self‐determination across methodologies in different healthcare settings. Methods: An integrated five‐stage review. Results: Forty‐five eligible papers were included. Guided self‐determination was applied in full‐ or small‐scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention‐deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self‐determination reduces disease‐related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets—appreciated but challenging tool to prompt insights and person‐specific knowledge, (4) New person‐specific knowledge enables person‐centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice—a decision from above, (2) A new role—unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person‐centred approach. Conclusion: Overall, guided self‐determination proved to have a great impact on patient important outcomes and was useful and well‐accepted by the majority of patients and healthcare professionals. Albeit guided self‐determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self‐determination to enhance adoption and sustainability in clinical practice. [ABSTRACT FROM AUTHOR]

Watchful waiting is a concept that is traditionally not associated with severe and enduring mental illness. This paper, however, boldly argues that the concept could be used as a ground‐breaking and accessible antidote to the perceived inequality experienced by black service users experiencing both mild and severe mental illnesses in England. The novel concepts proposed in this paper are not intended to be consensual, but rather uncompromising to provoke critical thinking in mental health practice. A conceptual framework for watchful waiting in mental health is suggested. [ABSTRACT FROM AUTHOR]

Background: In July 2022, self‐collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self‐collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self‐collection among this population. Methods: Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. Results: Women were motivated by the choice to self‐collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient‐centred models of care. Perceived barriers to self‐collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self‐collection. Conclusion: Self‐collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self‐collection can play in increasing equity in Australia's cervical screening programme. Patient or Public Contribution: Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research. [ABSTRACT FROM AUTHOR]

The intertwining ideas of self-determination and well-being have received tremendous support in western bioethics. They have been used to reject medical paternalism and to justify patients’ rights to give informed consent (or refusal) and execute advanced directives. It is frequently argued that everyone is thoroughly unique, and as patients are most knowledgeable of and invested in their own interests, they should be the ones to make voluntary decisions regarding their care. Two results of the strong focus on autonomy are the rejection of the image of patients as passive care recipients and the suspicion against paternalistic influence anyone may have on patients’ decision-making process. Although the initial focus in western bioethics was on minimizing professional coercion, there has been a steady concern of family’s involvement in adult patients’ medical decision-making. Many worry that family members may have divergent values and priorities from those of the patients, such that their involvement could counter patients’ autonomy. Those who are heavily involved in competent patients’ decision-making are often met with suspicion. Patients who defer to their families are sometimes presumed to be acting out of undue pressure. This essay argues for a re-examination of the notions of autonomy and undue pressure in the contexts of patienthood and relational identity. In particular, it examines the characteristics of families and their role in adult patients’ decision-making. Building on the feminist conception of the relational self and examining the context of contemporary institutional medicine, this paper argues that family involvement and consideration of family interests can be integral in promoting patients’ overall agency. It argues that, in the absence of abuse and neglect, respect for autonomy and agency requires clinicians to abide by patients’ expressed wishes. [ABSTRACT FROM AUTHOR]

Solidarity remains an ambiguous concept despite the long political tradition pertaining to concepts of fraternity, togetherness and collective values or goals. In healthcare ethics, it has been under‐explored, perhaps due to the perception that it opposes individual autonomy. However, even where autonomy is interpreted as a liberal construct, the solidaristic act may be borne out of free choice, rather than stand in opposition to it. To complement the existing scholarship, the concept of 'conjoint solidarity' in healthcare is proposed. Conjoint solidarity may be defined as 'the shared goal of all healthcare stakeholders (encapsulating all healthcare practitioners and service users) to accept or adopt a duty to assist one another to achieve improved healthcare outcomes'. The practical application of both medical autonomy and conjoint solidarity is through the process of shared decision making. An epistemic approach may be applied to 'pool information' from healthcare practitioners and patients to determine what improved healthcare outcomes are. This collective approach may also serve to address healthcare issues such exclusion, othering, paternalism and conflict of interest. Furthermore, in extending this relational approach to justice, consideration may be given to how improved healthcare may be attained in a manner that allows patients to also play their part. To this end, medical autonomy, conjoint solidarity and relational distributive justice may be considered interdependent constructs, which, when fully utilized, may help improve healthcare. [ABSTRACT FROM AUTHOR]

In recent years, there has been an increased focus on patient involvement in treatment planning in the health care system. To reduce the risk of the clinician moving towards paternalism, various methods have been introduced—shared decision making, among others. The goal of shared decision making is for the clinician and patient to share available evidence on the best treatment and to raise awareness on the needs and preferences of the patient as to make a genuinely informed choice. However, in the present article, we discuss to which degree paternalism can be avoided in light of the clinician's role as an authority with certain knowledge and expertise. Through the philosophical theory of reasons‐responsiveness, we discuss to which extend free will and control applies to the patient. Through theoretical analysis, we come to suggest that the clinician has a role as an ally rather than manipulator. [ABSTRACT FROM AUTHOR]

The article explores the moral bases of the different questions a patient's surrogate decision-maker might have to answer. The surrogate must step in when a patient is declared not competent and a treatment decision must be made. The surrogate should try to determine the patient's hypothetical choice if there is no clear expression of actual choice. Self-determination refers to the capacity to make a choice by assessing the advantages and disadvantages of competing alternatives. According to bioethics orthodoxy, the patient's autonomy and best interests are the central issues in surrogate decision-making.