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Irvine A, Drew P, Bower P, Ardern K, Armitage CJ, Barkham M, Brooks H, Connell J, Faija CL, Gellatly J, Rushton K, Welsh C, Bee P. 'So just to go through the options…': patient choice in the telephone delivery of the NHS Improving Access to Psychological Therapies services. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:3-19. [PMID: 32959917 DOI: 10.1111/1467-9566.13182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
This article considers patient choice in mental healthcare services, specifically the ways that choice is enabled or constrained in patient-practitioner spoken interaction. Using the method of conversation analysis (CA), we examine the language used by practitioners when presenting treatment delivery options to patients entering the NHS Improving Access to Psychological Therapies (IAPT) service. Analysis of 66 recordings of telephone-delivered IAPT assessment sessions revealed three patterns through which choice of treatment delivery mode was presented to patients: presenting a single delivery mode; incrementally presenting alternative delivery modes, in response to patient resistance; and parallel presentation of multiple delivery mode options. We show that a distinction should be made between (i) a choice to accept or reject the offer of a single option and (ii) a choice that is a selection from a range of options. We show that the three patterns identified are ordered in terms of patient-centredness and shared decision-making. Our findings contribute to sociological work on healthcare interactions that has identified variability in, and variable consequences for, the ways that patients and practitioners negotiate choice and shared decision-making. Findings are discussed in relation to tensions between the political ideology of patient choice and practical service delivery constraints.
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Affiliation(s)
- Annie Irvine
- Department of Language and Linguistic Science, University of York, York, UK
| | - Paul Drew
- Department of Language and Linguistic Science, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Kerry Ardern
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Janice Connell
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cintia L Faija
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Charlotte Welsh
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Fatigante M, Heritage J, Alby F, Zucchermaglio C. Presenting treatment options in breast cancer consultations: Advice and consent in Italian medical care. Soc Sci Med 2020; 266:113175. [PMID: 32987310 DOI: 10.1016/j.socscimed.2020.113175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/11/2020] [Accepted: 06/25/2020] [Indexed: 01/05/2023]
Abstract
Variety, complexity and uncertainty in the therapy outcomes of cancer illness make the treatment recommendation (TR) in oncology a "monumentally difficult task". Previous studies have distinguished unilateral and bilateral formats of treatment recommendations, accordingly to whether, or to what extent, the patient's perspective is included in the consideration of therapeutic options. Others have also shown how the oncologists' presentation of therapeutic options varied accordingly to the severity of the diagnosis and the availability of alternatives. Yet, no study has systemically dentified and compared components of treatment recommendation in oncology on a common set of patients and clinicians. This paper analyzes how different options in breast cancer treatments - radiotherapy, hormone therapy and chemotherapy - are presented and discussed in a set of 12 first post-surgical breast cancer visits carried out by two oncologists of high experience and seniority in two Italian hospitals. Treatment recommendation sequences involving these three option types were analyzed using the methods of conversation analysis. They were also coded for the mention of side effects and treatment burden, and for whether consent to the recommendation was invited, or expressed by the patient. Results show that radiotherapy is presented as presupposed as an extension of surgery and is not further discussed, and hormone therapy is delivered as good news and as not implying any health or lifestyle burdens. Treatment burdens were raised in the much more extensive discussions of chemotherapy, which were also accompanied by a higher chance that the patient was asked for consent to therapy. Implications are drawn as regards the extent to which clinical practice meets theory in communication protocols available in oncology, and how to consider the doctor-patient partnership and the concept of shared decision-making in such an encounter.
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Affiliation(s)
- Marilena Fatigante
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy.
| | - John Heritage
- Department of Sociology, University of California, Los Angeles, USA
| | - Francesca Alby
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
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Uhre J. The dialogic construction of patient involvement in patient-centred neurorehabilitation. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2018. [DOI: 10.4081/qrmh.2018.7792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper explores how the practice of patient involvement in neurorehabilitation is constructed in tension-riddled professional narratives. I adopt dialogic communication theory to focus on how involvement is constructed across different roles and voices. My analysis is based on an action research project that uses a dialogical communication perspective and participatory methods to explore patient-centred care through the eyes of healthcare professionals. I argue that patient involvement is constructed as a demanding process that requires memory, presence, communicative abilities and temporal understanding of personal needs. These requirements are not explicit in the situated institutionalized practices. As well, I show how the available involvement strategies are laced with taken for granted characteristics, which fall short in the situation that arises when patients do not have the ability to participate or play the role of an active patient. The findings in this paper contribute to the growing literature on patient-centred healthcare by empirically investigating how the discursive configuration of patient, health professional and institutional practices intertwine in producing certain inherent expectations, habits and taken for granted perspectives in care delivery. I also suggest that the findings can usefully be incorporated into patient-centred care design and organizational strategies in order to take into account both the patient, relatives and healthcare professionals as vital for creating a patient-centred practice, organization and professional environment.
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