Appropriating and asserting power on inflammatory arthritis teams: A social network perspective

Abstract

Background Therapeutic interventions for people with inflammatory arthritis (IA) increasingly involve multidisciplinary teams and strive to foster patient‐centred care and shared decision making. Participation in health‐care decisions requires patients to assert themselves and negotiate power in encounters with clinicians; however, clinical contexts often afford less authority for patients than clinicians. This disadvantage may inhibit patients' involvement in their own health care. Objective To identify communication attributes, IA patients use to influence and negotiate their treatment with members of their health‐care network. Method A qualitative social network approach was used to analyse data from a larger study that investigated IA patients' overall experiences of multidisciplinary care. Fourteen patients with IA attended individual semi‐structured interviews. Researchers used thematic analysis to identify patterns of assertiveness and influence in the data. Results Participants experienced loss of identity, control and agency in addition to the physical symptoms of IA. However, they had a sense of personal responsibility for managing their health care. Perceptions of health‐care team support enhanced patients' influence in treatment negotiations. Notably, there appeared to be an underlying tension between being empowered or disempowered. Discussion and conclusions The findings have significant implications for treatment decision communication approaches to IA care. A social network perspective may provide a pathway for clinicians to better understand the complexities of communication with their patients. This approach may reduce unequal power dynamics that occur within clinician/patient interactions and afford people with IA agency, control and affirmation of identity within their health‐care network.

Networks of Care: A Social Network Perspective of Distributed Multidisciplinary Care for People With Inflammatory Arthritis

“…The process of listening is intrinsic to fostering whole person care ( 11 , 19 , 21 , 30 ). We have previously reported the consequences of not being listened to for the patients in this study ( 31 ). Not being listened to is a barrier to patient involvement in treatment negotiations, fractures communication ties, and can create tension in clinician−patient relationships ( 31 ).…”

“…We have previously reported the consequences of not being listened to for the patients in this study (31). Not being listened to is a barrier to patient involvement in treatment negotiations, fractures communication ties, and can create tension in clinicianÀpatient relationships (31). Insufficient physician and specialist consultation time restricts discussion of patients' overall needs and is problematic for patients and health care providers (13,14,19,21).…”

Occupational Therapy Is a Vital Member of the Interprofessional Team‐Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

“…Individual people with RA can request that their rheumatologists refer them to OT for care. To facilitate the integrative care as recommended by the 2022 ACR Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis, rheumatology practices might consider including health professionals, such as occupational therapists, physical therapists, and dieticians, as part of their staff and develop clinical care systems that include multidisciplinary therapists as a complete package of treatment for people with rheumatologic conditions (16,55,56). If including additional personnel is not feasible, rheumatologists could consider collaborating with local occupational therapists to develop robust referral patterns.…”

23.4 Briefing

“…The authors write ‘Emphasizing patients' illness accounts as a pathway to foster ties through which power and identity can be co‐constructed may be critical if patients are to be agentic partners in their treatment decisions and gain control of their health‐care management’. This suggests the importance of re‐imagining organizational structures that support the agency of patients in treatment decision‐making and that make a place for patients’ lived experience alongside professional expertise, research and organizational or public policy 10 …”