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026 When autonomy meets justice: the barriers to implementing shared decision-making in breast cancer care
  1. Paulina Bravo1,
  2. Angelina Dois2
  1. 1Fundación Arturo López Pérez, Santiago de Chile
  2. 2School of Nursing, Pontificia Universidad Católica de Chile


Introduction A national law has recently regulated cancer care in Chile. The document highlights the importance of delivering patient-centred care and involving patients in all decisions related to their health. One of the central rights supported by Chilean law is to ensure that patients access timely healthcare. This is particularly relevant for breast cancer (BC), as women have guaranteed access to treatment from diagnosis to end of life. Therefore, it is necessary to explore the participation of the women in decision- making regarding their treatment for BC.

Methods A qualitative study was conducted. Eighteen health professionals (medical oncologists, ra diologists, and surgeons) who were members of tumour boards at three hospitals participated. Individual in-depth interviews were conducted. Open and axial coding was done. Ethical approval was granted at each hospital.

Results Participants recognised the importance of women’s participation in treatment. However, public policy forces them to follow a strict protocol that defines the medicines according to the disease’s stage and the tumour’s type. Patient participation is limited to accepting the treatment that the GES covers; otherwise, they can access healthcare with private providers, assuming out-of-pocket costs.

Discussion BC could be a devastating event for women, considering the treatment, prognosis, and affected quality of life. Although the current public policy seeks to promote patient-centred care, this tensioned two ethical principles: justice and autonomy.

Conclusion By ensuring coverage and access to care, the right to participation, considered a central element of the right to health, is violated, ignoring women´s autonomy in decisions related to their care and their rights and duties regarding the actions associated to their health care. In this sense, the active participation of women is restricted to a minority group with the economic capacity to cover the costs of care outside the state guarantee, which widens the gap in health inequities.

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