SummaryA systematic review of the literature about patients' preferences for involvement in cancer treatment decision making was conducted. Establishing preferences is important if the aim is to make health care more sensitive to the needs and expectations of each individual patient. Thirty-one papers were included in the review. Generalising from this literature is problematic because of limitations related to sample size, sample composition and methods used to assess preferences. Whilst we take cognizance of these limitations, research suggests that preferences vary considerably and that whilst most patients prefer a collaborative role, a significant minority prefer a passive or active role. Evidence about the association of factors such as age, gender, level of education, marital status, socioeconomic status and health status with preferences is inconclusive. Only a handful of studies investigated the degree of congruence between patients' role preferences and the actual role that they perceived they had played, which highlight that some patients experience a dissonance between the two. Similarly, few studies investigated the impact of this dissonance on patient anxiety or satisfaction with the treatment decision. We advocate more rigorous investigations before recommendations for health care professionals can be processed with confidence.

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The purpose of the literature review was to find out why people affected by cancer have been involved in research; how they have been involved and the impact of their involvement. We used systematic methods to search for literature, applied inclusion and exclusion criteria, conducted a quality appraisal, selected relevant data from the included articles for analysis, and provided a narrative summary of these data. The literature shows that people affected by cancer, particularly women with breast cancer, have been involved in a range of research programmes, projects and initiatives especially in the USA, UK, Canada and Australia. Their involvement has impacted upon research design, accrual and response rates. There is increasing recognition of the need for an infrastructure, including formal recruitment procedures, training and mentoring, to support an agenda of involvement and a need to challenge the ethos of traditional research, which does not easily lend itself to this agenda. Further critique of the role of 'experiential knowledge' in research is required so that researchers and people affected by cancer can work in partnership.

BackgroundRoutinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.MethodsTwo complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.ResultsWe identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.ConclusionThe introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

The government's reimbursement policy, whereby local councils face fines if a patient cannot be discharged from hospital because they are waiting for an assessment etc, introduced new pressures into a system that was already fraught. One of the policy's aims is to allow people to exercise ‘genuine choice’ as regards their ongoing and longer-term care. Based on their research into the policy however, Michelle Cornes et al investigate whether choice really can be exercised when lying in a hospital bed