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Patients' experiences of communication and involvement in decision-making about atrial fibrillation treatment in consultations with nurses and physicians
Sophiahemmet University.
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2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, 535-46 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Insights in consultations across patient interactions with physicians and nurses are of vital importance for strengthening the patients' involvement in the treatment decision-making process. The experience of involvement and communication in decision-making from the patients' perspective has been sparsely explored.

OBJECTIVE: To examine how patients describe involvement in and communication about decision-making regarding treatment in consultations with nurses and physicians.

METHOD: Twenty-two patients with atrial fibrillation (AF), aged 37-90 years, were interviewed directly after their consultations with nurses and physicians in outpatient AF clinics in six Swedish hospitals.

RESULTS: In consultations with nurses, the patients felt involved when obtaining clarifications about AF as a disease and its treatment and when preparing for and building up confidence in decision-making. In consultations with physicians, the patients felt involved when they could cooperate in decision-making, when acquiring knowledge, and when they felt that they were being understood. One shared category was found in consultations with both nurses and physicians, and the patients felt involved when they had a sense of trust and felt secure during and between consultations.

CONCLUSIONS: Patients with AF stated that they would need to acquire knowledge and build up confidence and ability in order to be effectively involved in the decision-making about treatment. Despite not being actively involved in decision-making, patients felt involved through experiencing supportive and confirming communication.

PRACTICE IMPLICATIONS: Attention must be given to the relationship with the patient to create the conditions for patient involvement in the consultation. This can be achieved through supportive communication attempting to create a feeling of clarity and building confidence. This will support involvement in decision-making concerning AF treatment and feelings of being understood and of trust in physicians and/or nurses.

Place, publisher, year, edition, pages
2016. Vol. 30, no 3, 535-46 p.
Keyword [en]
Atrial fibrillation, Communication, Consultation, Decision-making, Participation, Patient involvment
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-2017DOI: 10.1111/scs.12276PubMedID: 26709843OAI: oai:DiVA.org:shh-2017DiVA: diva2:889887
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2016-10-04Bibliographically approved
In thesis
1. Communication in Patient Involvement in Decision making: Examples from consultations on atrial fibrillation
Open this publication in new window or tab >>Communication in Patient Involvement in Decision making: Examples from consultations on atrial fibrillation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2016. 81 p.
Keyword
Communication, Patient involvement, Shared decision making, Atrial fibrillation, Interaction, Patient participation, Person-centered care, Resistance, Discursive space, Consultation
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-2171 (URN)978-91-7676-042-0 (ISBN)
Public defence
2016-01-22, Weitnersalen, Sophiahemmet University, Valhallavägen 91, Hus R, Stockholm, 09:30 (English)
Opponent
Supervisors
Available from: 2016-06-15 Created: 2016-04-01 Last updated: 2016-06-15Bibliographically approved

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Citation style
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