Interprofessional practice has become increasingly important. In addition, patients are expected to participate more actively in health-care decisions. While comprehensive discharge planning has been shown to be effective, it is unclear how interactional structure influences patients' participation during discharge planning meetings. The aims of this qualitative study were to examine the interactional structure of interprofessional meetings in two rehabilitation clinics and to identify patients' types of communicative involvement (patient participation) during discharge planning meetings. Using an ethnomethodological approach and Conversation Analysis, 121 interprofessional meetings were video-recorded (19 hours of recordings). Twenty-five patients (30-87 years) with neurological or musculoskeletal disorders and their teams were included. The findings revealed two types of meetings aimed at either (a) exchanging information with team members and patient ("information exchange meeting") or (b) negotiating care plans with patients and the team. "Negotiation meetings" were often led by allied health professionals or nurses and were characterized by active patient participation. Those meetings offered patients an opportunity to give additional information rather than only ask questions. The discussion includes reflections on how interactional analysis can help understand the social organization of meetings and how patient participation can be enhanced in this context and concludes with practice implications.
Clinical guidelines require the patient’s participation in the entire rehabilitation process, including discharge planning. However, very little is known about how this institutional requirement is actually dealt with in everyday clinical practice. Adopting a conversation analytic approach, our paper tackles the matter, looking at situations in which patients achieve interactional initiatives within interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients’ rehabilitation goals and to plan their discharge, the paper offers a detailed analysis of two conversational environments in which patients accomplish initiatives: incipient disagreement among the interdisciplinary team and difficulties faced by the professionals in moving towards the formulation of a goal. In both situations, the progress of the activity is at stake. Moreover, the analysis reveals the interactive and stepwise accomplishment of patients’ initiatives. Our paper argues that shedding light on how patients’ initiatives are interactively implemented makes it possible to discuss how issues of epistemic rights and entitlement to participate are locally negotiated. In the final discussion, the paper raises the question of how patients’ competence in intervening in the goal-formulation activity can be taken into account in clinical guidelines on patient participation.
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