Editorial

There are some big changes at Health Expectations. From January 2014, the Journal will only be available online and no longer be published in print. This change will allow us to produce six issues a year instead of the current four. As part of this transition, this issue will include seven additional articles in an online-only format. The first set of articles relate to patient involvement in research. Teunissen et al.1 report the findings of a data inventory synthesis on patient involvement in research and quality of care that extends a systematic review approach to include secondary and tertiary sources. By contrast, Kreis et al.2 draw on in-depth interview with key informants to explore how consumers are involved in systematic reviews. Using focus groups with American clinicians, clinical staff, researchers and patient advocates as part of a half-day workshop reviewing the results of a systematic evidence review, Gold et al.3 set out an approach to identifying research priorities. The impact of a centrally organized approach to involving patients in research is considered by Iliffe et al.4 who used case studies of different research projects conducted as part of a disease research network. Taken together, these articles demonstrate not only the diverse ways that patients and the public are increasingly being incorporated in to different kinds of research internationally but also the value of and impact that this involvement has on the research process and outcomes. The next two articles relate to the impact of physicians perceptions and attitudes on communication and involvement in treatment decision-making. Portnoy et al.5 using survey data from 1500 American primary care physicians explore the extent to which they communicate scientific uncertainty in relation to treatment decisions to their patients. They conclude that the characteristics of the physicians and their perception of a patient's tolerance of uncertainty determined their approach but that in their sample female physicians were more paternalistic. In the next article, O'Brien et al.6 explore how physician–patient verbal and nonverbal communication can facilitate or limit women with being involved in decisions about their own treatment. Based on interviews with 40 women and six physicians drawn from three academic clinical settings, they conclude that it was primarily for women who wanted to participate that the nature and content of the physician's communication impacted on shared decision-making. This suggests that doctor's explanation of the rationale for shared decision-making should be a central element of such consultations. The online-only section of this issue returns to the subject of research, but Sweeney et al.7 focus on differences in research practice between service-user, clinical and psychology assistant in coding focus group data on cognitive behavioural therapy for psychosis. They argue that adopting multiple coding as an analytical tool encouraged synthesis and also enabled the identification of points of difference that were then used as the basis for interviews and a Delphi survey. Multiple coding created more robust and insightful research by making the process of analysis more manifest. Clinical trials are an area where patient involvement is often more challenging. Gooberman-Hill et al.8 convened two discussion groups composed of members of two existing user involvement group to consider key features of a credible placebo splint as part of the design of a randomized osteoarthritis clinical trial. The next three articles consider people's experience of care. Kuluski et al.9 examined the experiences of 116 Canadian hospital in-patients with complex chronic disease using a semi-structured questionnaire to identify the key components of care delivery. Using a different approach McFadden, Renfrew and Atkin studied the importance of culture in shaping patient experience and expectations in breast-feeding Bangladeshi women.10 Their findings suggest that practitioners were insufficiently aware of how cultural context makes a difference to women's experiences of breast-feeding and breast-feeding support and as importantly that sometimes their needs are identical to those of the majority population. The relationship between the technical quality of treatment and patient's experience of care while correlated are not interchangeable was a central finding of Arah et al.11 study of secondary data from a cross-sectional survey of 3096 people with diabetes in the Netherlands. The final two articles in this issue continue the focus on what is important to patients. Wale et al.12 detail the development and application of an online survey to prioritize review titles from the Cochrane Library. The 321 users of health services that completed the survey identified 19 health areas as priorities and these choices tended to stress lifestyle and non-medical interventions as important. The articles in this issue (both in print and online) illustrate both the international nature of Health Expectations and the continued evolution of shared decision-making and patient and public involvement in policy and practice. Moving to an online-only version of the Journal will allow us to publish more articles and publish them more quickly helping to promote debate and disseminate evidence from around the world. Also engaging with issues of communication and its impact, Davis et al.13 examined patients’ attitudes towards a video and leaflet aimed at encouraging patient involvement in safety-related behaviours. The findings from two exploratory studies involving 106 medical and surgical inpatients from two acute hospitals confirm that exposure to the communication materials can increase people's comfort in participating in some safety-related behaviours although many respondents did not think they could positively contribute to their safety in health care. This issue brings together evidence from a range of countries employing different methodologies but all reinforcing the continued growth of the application of patient and public involvement to research, professional and service development. Changing professional practice is a challenge. While legislation and protocols may support more patient-centred practice shifts in normative expectation of the role of patients and the public in generating evidence is likely to have a significant part to play in changing professional norms. Those of us who do research and train healthcare professionals also need to champion a different relationship between those who provide health care, those that shape healthcare policy and those who receive services.

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