Communication and patient involvement in decision making : examples from consultations on atrial fibrillation
Author: Siouta, Eleni
Date: 2016-01-22
Location: Sophiahemmet University, Weitnersalen, Vallhallavägen 91, Hus R, Stockholm
Time: 09.30
Department: Inst för lärande, informatik, management och etik / Dept of Learning, Informatics, Management and Ethics
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Thesis (840.4Kb)
Abstract
Background: Further knowledge is needed regarding communication that occurs in practice between patients with atrial fibrillation (AF) and health professionals in consultations to understand the issue of patient involvement in treatment decisions.
Overall aim: The overall aim of this thesis is to contribute knowledge on communication between patients and health professionals (cardiology nurses and cardiologists), focussing on how they create involvement in decision making in consultations.
Specific aims: (1) To describe (i) the topics that patients with AF discuss with cardiology nurses and cardiologists; (ii) the use of discursive space in consultations between these participants; and (iii) the frequency at which patients, cardiology nurses, and cardiologists introduce identified topics. (2) To describe the different types of resistance by patients to treatment with warfarin and how cardiologists respond to such resistance. (3) To examine how patients describe involvement and communication in decision making regarding treatment in consultations with cardiology nurses and cardiologists. (4) To examine how cardiologists describe their views on patient involvement in AF treatment decisions, their perceptions regarding efforts to involve patients, and how they handle decisions.
Methods: A qualitative design was used. In study I, the sample consisted of 23 videotaped consultations between patients with AF and cardiology nurses and cardiologists at six nurse-led cardiology outpatient clinics. Content analysis was used to obtain a description of topics that were discussed. The patterns of dominance for the various topics and participants were examined. In study II, the sample consisted of 11 videotaped consultations between patients with AF and cardiologists. Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. In study III, 22 patients with AF were interviewed directly after their consultations with cardiology nurses and cardiologists. Content analysis was used for the resulting data. In study IV, 10 cardiologists were interviewed in cardiology clinics at four Swedish hospitals and qualitative content analysis was used.
Findings: In study I, a medically driven agenda dominated the patient-driven agenda. However, when the patients initiated conversations about their life with AF (the topic that received the least amount of space on the agenda), involvement was created. In study II, the patients’ resistance could be viewed as a source of knowledge about patients’ real-life situations and what motivates them. In study III, despite not being actively involved in the decision-making process, the patients experienced a sense of involvement when they felt understood and were listened to. In study IV, by taking into account the patients’ feelings in the consultations, and by actively encouraging the patients to be involved, the cardiologists contributed to patient involvement.
Conclusions: Patients, cardiology nurses, and cardiologists create involvement in decision making in consultations as communicative projects. Patients strive for space and create involvement by showing resistance to the decisions suggested by health professionals. However, involvement is not only an issue about obtaining space in the consultations, but is also associated with obtaining clarification, building confidence, feeling understood, trusting cardiology nurses and cardiologists, and having confidence in receiving consistent care within an established relationship. On a theoretical level, this thesis sheds light on the interaction between the concepts of communication, involvement, and decision making.
Overall aim: The overall aim of this thesis is to contribute knowledge on communication between patients and health professionals (cardiology nurses and cardiologists), focussing on how they create involvement in decision making in consultations.
Specific aims: (1) To describe (i) the topics that patients with AF discuss with cardiology nurses and cardiologists; (ii) the use of discursive space in consultations between these participants; and (iii) the frequency at which patients, cardiology nurses, and cardiologists introduce identified topics. (2) To describe the different types of resistance by patients to treatment with warfarin and how cardiologists respond to such resistance. (3) To examine how patients describe involvement and communication in decision making regarding treatment in consultations with cardiology nurses and cardiologists. (4) To examine how cardiologists describe their views on patient involvement in AF treatment decisions, their perceptions regarding efforts to involve patients, and how they handle decisions.
Methods: A qualitative design was used. In study I, the sample consisted of 23 videotaped consultations between patients with AF and cardiology nurses and cardiologists at six nurse-led cardiology outpatient clinics. Content analysis was used to obtain a description of topics that were discussed. The patterns of dominance for the various topics and participants were examined. In study II, the sample consisted of 11 videotaped consultations between patients with AF and cardiologists. Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. In study III, 22 patients with AF were interviewed directly after their consultations with cardiology nurses and cardiologists. Content analysis was used for the resulting data. In study IV, 10 cardiologists were interviewed in cardiology clinics at four Swedish hospitals and qualitative content analysis was used.
Findings: In study I, a medically driven agenda dominated the patient-driven agenda. However, when the patients initiated conversations about their life with AF (the topic that received the least amount of space on the agenda), involvement was created. In study II, the patients’ resistance could be viewed as a source of knowledge about patients’ real-life situations and what motivates them. In study III, despite not being actively involved in the decision-making process, the patients experienced a sense of involvement when they felt understood and were listened to. In study IV, by taking into account the patients’ feelings in the consultations, and by actively encouraging the patients to be involved, the cardiologists contributed to patient involvement.
Conclusions: Patients, cardiology nurses, and cardiologists create involvement in decision making in consultations as communicative projects. Patients strive for space and create involvement by showing resistance to the decisions suggested by health professionals. However, involvement is not only an issue about obtaining space in the consultations, but is also associated with obtaining clarification, building confidence, feeling understood, trusting cardiology nurses and cardiologists, and having confidence in receiving consistent care within an established relationship. On a theoretical level, this thesis sheds light on the interaction between the concepts of communication, involvement, and decision making.
List of papers:
I. Siouta, E., Broström, A. and Hedberg, B. (2013). Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals. European Journal of Cardiovascular Nursing, 12(1):47-55.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Siouta, E., Hedberg, B., Hedman, K. and Broström, A. (2012). Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision making. The International Journal of Person Centered Medicine, 2(3):427-436.
III. Siouta, E., Hellström Muhli, U., Hedberg, B., Broström, A., Fossum, B. and Karlgren, K. (2015). Patients’ experiences of involvement and communication in decision making about atrial fibrillation treatment in consultations with nurses and physicians. [Accepted]
Pubmed
IV. Siouta, E., Hellström Muhli, U., Fossum, B. and Karlgren, K. (2015). Nurses’ and physicians’ experiences of patient involvement and communication in shared decision making about atrial fibrillation treatment in consultations with nurses and physicians. [Manuscript]
I. Siouta, E., Broström, A. and Hedberg, B. (2013). Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals. European Journal of Cardiovascular Nursing, 12(1):47-55.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Siouta, E., Hedberg, B., Hedman, K. and Broström, A. (2012). Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision making. The International Journal of Person Centered Medicine, 2(3):427-436.
III. Siouta, E., Hellström Muhli, U., Hedberg, B., Broström, A., Fossum, B. and Karlgren, K. (2015). Patients’ experiences of involvement and communication in decision making about atrial fibrillation treatment in consultations with nurses and physicians. [Accepted]
Pubmed
IV. Siouta, E., Hellström Muhli, U., Fossum, B. and Karlgren, K. (2015). Nurses’ and physicians’ experiences of patient involvement and communication in shared decision making about atrial fibrillation treatment in consultations with nurses and physicians. [Manuscript]
Institution: Karolinska Institutet
Supervisor: Fossum, Bjöörn
Issue date: 2015-12-30
Rights:
Publication year: 2016
ISBN: 978-91-7676-042-0
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