?Things aren't the same, are they??: The management of bad news delivery in the discourse of stroke care

Abstract

Health professionals associated with stroke care tend to emphasize the optimistic possibilities for recovery from stroke and downplay its disabling nature. Therefore, unlike in cancer care, the 'bad news' interview is not a recognized part of stroke care. Nevertheless, at some stages in the trajectory of the illness the issue of disability may have to be discussed and this paper concerns one such occasion. The data are taken from a corpus of video-recorded naturally occurring interactions between stroke patients and health professionals. In the case studied here, an occupational therapist discusses with a patient the arrangements for her care after discharge from hospital. It emerges over the course of the interaction that the patient has to face some unpleasant realities about her future daily life. By conducting a microanalysis of this interaction, using appropriate concepts from conversation analysis and politeness theory, we show how the patient and therapist collaboratively manage the emergent 'bad news' situation and, over the course of the interaction, arrive at the realization that 'things are not the same'.

Breaking bad news in stroke rehabilitation: a consultation with a community stroke team

“…This model is called COMFORT, an acronym for its seven empirically based core competencies labelled as communicating, orientation, mindfulness, family, ongoing, reiterative and team working (see Table I). Presented literature also included discussion of stroke specific challenges and findings exploring communication and management of disappointment in stroke [2][3][4]15]. Theory-practice links were made throughout.…”

“…To date, whilst the importance of communication in stroke recovery [2] and the need to explore patients' expectations of recovery has received attention [3], only one qualitative paper could be found which considers the management of BBN in stroke care [4]. Grainger et al (2005) discuss the particular challenges inherent for health professionals delivering bad news in stroke care settings.…”

“…Grainger et al (2005) discuss the particular challenges inherent for health professionals delivering bad news in stroke care settings. These include the uncertainty existing around prognosis and recovery, delivery of news which is not necessarily life threatening but may be life-changing and the need to deliver messages in such a way which fosters hope and optimism, essential to enhance rehabilitation.…”

Breaking the news: A pilot study on patient perspectives of discussing prognosis after traumatic spinal cord injury

“…Post stroke, patients and caregivers reportedly want to know information regarding prognosis and recovery early in the acute period. 13 One report discussed delivering bad news in the stroke population 14 and another described a formal training program for a stroke rehabilitation team 15 using the COMFORT technique. 16 In the developmental disability literature (e.g.…”

La comunicación de malas noticias en el daño cerebral aquirido: ¿mucha ciencia pero tal vez poca complacencia?

“…Esta falta de empatía es percibida por la familia o el paciente, que tienden a calificar el encuentro clínico de frío, despersonalizado y escaso de tiempo 10,16,24,25 . La literatura también destaca que muchas veces los médicos no siempre son conscientes de los posibles defectos en la comunicación 26,27 .…”