Background: For the patient-doctor relationship several models are discussed: "Paternalistic", "Informed consent" and "Shared decision making". Our study group aims to evaluate in how far the concept of SDM can be transferred into praxis when dealing with terminally ill cancer patients. In order to adequately reproduce the perspectives of the involved groups, we started doing narrative interviews, aiming to generate hypothesis for quantitative analysis.
Methods: We did 16 narrative interviews with patients, relatives and health professionals, which were evaluated using the methods "Grounded Theory" and "Objective Hermeneutics" in order to extract items for questionnaires appropriate for patients, relatives and doctors. One example of a patient's statement: "An ultrasound of the stomach was done...of the breast, the remaining one...and I said I was so tired and broken,...an ultrasound of the thyroid was done, but no chest x-ray, I don't know why". We generated the item "As a patient, you feel somehow at the system's mercy."
Results: About 52% of patients fully or rather agreed with the item, 48% rather or fully disagreed. Relatives agreed to an even higher percentage (63%), wheras doctors agreed in only 24%. Altogether, the items generated using qualitative methods have been successfully applied. So far, 272 patients, 66 relatives and 170 doctors answered the questionnaires.
Discussion: Our results show that it can be very useful to combine qualitative and quantitative research. Qualitative research is well suited to get in touch with new, so far unrealized aspects and hypothesis when entering new fields of interest. The quantitative part is to evaluate the common relevance of the above hypothesis. In our example, the views of the engaged actors can be confronted. Their different judgements of patients' autonomy within the system may account for some difficulties in implementing SDM.