A structurational analysis of informed consent to treatment: societal evolution, contradiction, and reproductions in medical practice

The Structuration of Community-Based Mental Health Care: A Duality Analysis of a Volunteer Group's Local Agency

Using a lens of structuration theory, this study highlights the ways that specific structures within the current community-based model of mental health care might enable and constrain individuals and families living with mental illness. Through a case study of a volunteer mental illness advocacy group, the authors employed a duality analysis on a variety of data collected from the case (i.e., interviews, organizational documents, and community health care data). Findings indicate that while group members encountered structural barriers to their organizational mission, they also used communicative agency creatively and collectively to (re)create structures within the current community-based model of mental health care. Member agency is examined in relation to perceived structural influence. Theoretical and practical applications of the findings are discussed.

An Integrative Methodology for Organizational Oppositions: Aligning Grounded Theory and Discourse Analysis

The study of organizational tensions, contradictions, dialectics, and paradoxes is on the rise in the organizational sciences. This article sets forth an integrative methodology for studying these oppositional phenomena by aligning grounded theory techniques with the little “d” and big “D” orientations of organizational discourse analysis. This integrative methodology not only aids in identifying and determining various types of organizational oppositions and responses to them, but also fosters assessment of their potential power effects and micro organizing dynamics. We provide detailed steps for undertaking this integrative methodology, illustrate these steps with an extended example, and conclude with a discussion of new directions for using this approach.

A dialectical perspective on informed consent to treatment: an examination of radiologists' dilemmas and negotiations

Informed consent to treatment (ICT), designed to honor patient autonomy, has been an important subject of inquiry in many disciplines. To foreground the dynamic and dilemmatic tendencies of ICT practice implied by previous inquiries, I advanced relational dialectics theory into the realm of physicians' experiences with ICT. On performing a dialectical analysis of transcripts from focus group discussions with radiologists, I found them experiencing four primary tensions: (a) between simple and complex ICT; (b) between radiologist and patient control; (c) between standardized and idiosyncratic practice (involving struggles between documentation and conversational process, and between vague and detailed language use); and (d) between withholding and disclosing alternatives. Moreover, I drew on concepts from relational dialectics theory to capture the various ways radiologists negotiate these dialectics. I conclude with practical applications for physician and patient training and interprofessional coordination.

Informed consent to treatment's sociohistorical discourse of traditionalism: a structurational analysis of radiology residents' accounts

Informed consent to treatment (IC) is designed to protect patient autonomy and control through disclosures and shared decisions. However, many malpractice claims suggest patients perceive problems with its handling (e.g., information withholding). Moreover, previous studies of IC lack the nuance of discursive perspectives, theoretical grounding, and recognition of IC's sociohistorical context. Drawing on a structurational perspective, which conceives of IC as constituted by contradictory sociohistorical structures (discourse formations) representing different groups' interests in controlling IC, this study examines how the structure representing physicians' interests is (re)produced in practice. Focus group accounts reveal how radiologists-drawing upon interpretive schemes of patients as fearful, ignorant, and easily controlled-discursively and skillfully manipulate IC language and information in engineering patients' decisions.

A structurational analysis of informed consent to treatment: (re)productions of contradictory sociohistorical structures in practitioners' interpretive schemes

Informed consent (IC) to treatment honors patient autonomy and bodily integrity. Yet, it is a leading reason for patient litigation, it has not been examined from discursive or theoretical perspectives, and its sociohistorical context is ignored. In a previous analysis of American IC law and the IC literature, structuration theory guided a reconceptualization of IC as unfolding amid contradictory sociohistorical structures or discursive formations-traditionalism, liability, and decision making-representing interests favoring a group's (physicians, states and administrative entities, and patients, respectively) control of IC. This study's focus groups with radiologists found them (re)producing these structures in their interpretive schemes of patients' reactions to IC, IC as protective paperwork, and IC as a patient- and relationship-centered process.