Limited conversations about constrained futures: exploring clinicians’ conversations about life after stroke in inpatient settings

Abstract

Background. After a stroke, people can find it challenging to look forward to the future. Hope, a critical resource for recovery, can be threatened and can be supported or diminished through interactions with clinicians. As such, understanding how conversations can support people embarking on life after a stroke is critical. Our study explored how clinicians talk about the future with patients and considered what factors shape how these conversations occur. Methods. This study drew on the Interpretive Description methodology, informed by principles of ethnographic inquiry. We conducted 300 hours of observations and 76 interviews with five people with stroke and 37 clinicians. Data were analysed using the reflexive thematic analysis. Results. We constructed three themes that reflect how clinicians talk about the future with people in inpatient stroke services: (1) constrained temporal horizons, (2) limited talk controlled by clinicians, and (3) opening some doors while closing others. Conclusions. Conversations about the future after stroke were constrained and limited: constrained to short-term futures and limited in what aspects of life after stroke were discussed. Creating conversational and relational spaces where people are supported to look to the future with a sense of possibility, hope, and potential is vital for assisting people to move forward in their lives after their stroke. Given its role in supporting people to move forward in their lives, communication must be seen as a core clinical skill and a clinical intervention in its own right.

Hope as experienced by people with acquired brain injury in a rehabilitation—or recovery process: a qualitative systematic review and thematic synthesis

“…This leaves us with the question of whether it is easier to maintain or instill hope in earlier stages of rehabilitation compared to later stages? A study by Bright et al showed that conversations about the future also seems to be constrained and limited in the inpatient setting poststroke ( 68 ). The study explored how clinicians talk about the future with patients and Bright et al found that these types of conversations were constrained to short-term futures and limited to what aspects of life after stroke were discussed.…”

“…According to Bright et al being able to create conversational and relational spaces where people are supported to look into the future with a sense of possibility, hope, and potential is vital for persons to move forward in their lives post stroke. Based on their findings they conclude that, communication must be seen as a core clinical skill and a clinical intervention in its own right ( 68 ).…”