• Katharina Seibel, Sara Celestina Valeo, Carola Xander, Sandra Adami, Thorsten Duerk, and Gerhild Becker.
• Department of Palliative Care, Medical Center - University of Freiburg , Freiburg, Germany .
• J Palliat Med. 2014 Jan 1;17(1):11-7.

BackgroundConsumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers.AimTo explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role.DesignQualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction.Setting/ParticipantsResearchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany.ResultsIn many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual.ConclusionsThe idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making.

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