Talking With Patients About Life After Stroke: What Happens in Stroke Services?

Abstract

Background: While people’s physical needs are commonly well-addressed within services, survivors report they feel psychologically unprepared for life after stroke and can struggle to think about the future. Supportive conversations about the stroke, its impacts and people’s desired future can assist people in their recovery journey, however, survivors report these conversations do not consistently happen in practice. Aims: The aim of this research was to identify how life after stroke is discussed in patient-clinician interactions in in-patient stroke services in Aotearoa. Methods: In this focused ethnography, we conducted 300 hours of observations of interactions between 5 people with stroke and 36 clinicians, and 76 interviews with these participants throughout each person’s in-patient length of stay. Data were analysed using reflexive thematic analysis. Results: Conversations about the future were limited. Conversations focused on the person’s medical condition, their impairments, and activities of daily living. When staff talked about the future, they focused on a constrained aspect of the future: the person’s functioning and anticipated support needs at or shortly after discharge. Many aspects of life after stroke that people with stroke consider important were not discussed. While clinicians recognised the importance of having these conversations, two things limited their interactions: feeling they did not have the time, and the feeling it was not the right time. Conclusion: Conversations about the future were limited, focusing on clinician-determined topics and timeframes within their control. The absence of conversation about the psychosocial elements of life after stroke contributes to people feeling unprepared for the future, potentially exacerbating the long-term impact of stroke on people. Understanding how life after stroke is and is not discussed allows us to critically consider how conversations can better support people’s recovery and provides insight into the supports clinicians need in order to have these supportive conversations.