Experiences and views of conversations about recovery and prognosis on the stroke unit: findings from semistructured interviews with professionals.

Abstract

Providing information about the process of poststroke recovery, and individuals' likely outlook can be challenging for professionals, which may lead to avoidance of this important issue, leaving patients' and carers' needs unmet in relation to understanding their recovery. We aimed to understand professionals' experiences and views of providing information about recovery in stroke units. Semistructured interviews were conducted as part of a wider ethnographic case study. A Framework approach to analysis was employed. Two UK stroke units. 19 qualified stroke unit professionals with a range of experience levels participated, including doctors, physiotherapists, occupational therapists, speech and language therapists and a nurse. Three themes and seven subthemes were generated. Participants across disciplines perceived that discussing recovery could have important benefits, although many lacked guidance about their roles in this domain. Skills in predicting recovery and sharing these predictions were learnt experientially, and therapists reported a lack of preparatory training and confidence, resulting in perceptions of mixed experiences for patients. Many professionals were worried about the consequences of sharing personalised predictions, including the impact on patients' hope and motivation, and their ability to manage patients' and families' emotional responses. These concerns could result in professionals experiencing negative psychological consequences, for which limited formal support was available. Stroke unit professionals perceive that providing information about recovery, including individualised predictions, to patients and carers has important benefits; however, they require additional guidance, support and training to confidently engage in this important area of clinical practice.