Patient Participation in Rehabilitation Centres: How Professionals Integrate Patients' Expectations about Discharge Plans

Today, patient participation is considered “best practice”. Yet, there are different perspectives on what patient participation means. While there is a line of argument that patient participation “is justified on humane grounds alone” and in line with patients’ right to self-determination (Guadagnoli & Ward, 1998), there is evidence that not all patients desire to be involved (Thompson et al, 2007). Policies on discharge planning from rehabilitation centres stipulate moreover that patients participate actively. It is less clear, however, how patient participation occurs and how this process is achieved interactionally. The goal of this paper is to analyse how patients participate in planning their discharge from rehabilitation centres in multidisciplinary meetings and within the health providers-patient interaction.

Three rehabilitation centres in Switzerland with a total of 37 patients and their teams of health professionals (physicians, nurses, occupational therapists, physiotherapists, etc.) participated in the study. Over 150 meetings were video recorded and analysed using Conversation Analysis, an inductive, observational method.

Patient participation is shaped by organisational structure, by health professionals’ communicative practices and by opportunities for patients to engage actively: 1) Patients participate in weekly interdisciplinary meetings, and have the opportunity to intervene directly and thereby shape decisions. 2) Primary nurses coordinate care for patients throughout their stay, and relay the patient’s point of view to other health professionals. Professionals’ way to integrate patients’ opinion into final decisions might differ significantly. 3) When interdisciplinary meetings are held without patients, the patients’ point of view is thus indirectly integrated into decision-making: different professionals work as mediators. The analysis of three sites allows a reflection on professional competencies and best practices with regard to patient participation and proposes recommendations for education and practice.