Astrid Pratidina Susilo1, Brahmaputra Marjadi2,3, Jan van Dalen4& Albert Scherpbier4

1Faculty of Medicine, University of Surabaya, Indonesia; 2Faculty of Medicine, Universitas Wijaya Kusuma Surabaya, Indonesia; 3School of Medicine, Western Sydney University, Australia; 4Faculty of Health, Medicine, and Life Sciences, Maastricht University, The Netherlands


Objective: To investigate patients’ decision-making in the informed consent process in a hierarchical and communal culture.

Methods: This qualitative study took place in an Indonesian hospital and was conducted in line with the Grounded Theory approach. Fifteen patients and twelve family members were interviewed to understand the patients’ decision-making process and factors that contributed to this process. Interview transcripts were analysed using the constant comparison method.

Results: Patients used information to develop an explanation of their illness and treatment. They consented to a medical procedure if information from their physicians matched their own explanation. An increasing severity of the disease urged patients to decide, even when a satisfying explanation had not been developed. A hierarchical relationship between physicians and patients hampered patients’ discussing concerns or sharing emotions with their physicians. To maintain a harmonious relation with their physicians, patients accepted that some questions remained unanswered even after a decision had been made.

Conclusion: The strong hierarchical and communal context added to the complexity in the physician-patient relationship and consequently influenced patients’ decision-making. In addition to strengthening physicians’ communication skills, involving other health professionals as patient advocates or mediators is recommended to ensure patients make voluntary and informed decisions.

Keywords:         Decision-making, Informed Consent, Hierarchical Culture, Communal Culture, Grounded Theory

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