Discussion
In this research, important outcomes of consultations for consumers included feeling respected and perceiving that they had contributed meaningfully to the process and discussions. The participants also wanted to feel that consultations and their care had been ‘individualized’ for them, and that complete and honest information had been provided. Other valued outcomes included the consumers perceiving that they were involved in decision-making, even leading the decision-making. Perhaps out of a sense of reality, recognizing that professionals will frequently exert a large degree of control through their access to the specialist knowledge base (‘power asymmetry’),21 many participants felt that actual involvement in the decision-making was less important than the level of perceived involvement. They also recognized that actual involvement and preferred levels of involvement would be ‘context dependent’, varying according to the nature, severity and chronicity of their condition. Thus, for example, more paternalistic styles might be more preferred in situations where the illness is more severe or acute, but the same individual might prefer greater involvement in decisions about more long-lasting illnesses and treatments. Participants placed a high value on ‘appropriate involvement’ according to the circumstances, and it seems that some role negotiation, however brief, or even implicitly rather than explicitly, should take place at the beginning of every consultation. In contrast to these ‘patient-based’ outcomes22 and comments on the process of consultations, these participants did not place a high value on compliance and other behavioural measures.