The dialogic construction of patient involvement in patient-centred neurorehabilitation


Submitted: 30 August 2018
Accepted: 19 December 2018
Published: 20 December 2018
Abstract Views: 987
PDF: 387
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Authors

This paper explores how the practice of patient involvement in neurorehabilitation is constructed in tension-riddled professional narratives. I adopt dialogic communication theory to focus on how involvement is constructed across different roles and voices. My analysis is based on an action research project that uses a dialogical communication perspective and participatory methods to explore patient-centred care through the eyes of healthcare professionals. I argue that patient involvement is constructed as a demanding process that requires memory, presence, communicative abilities and temporal understanding of personal needs. These requirements are not explicit in the situated institutionalized practices. As well, I show how the available involvement strategies are laced with taken for granted characteristics, which fall short in the situation that arises when patients do not have the ability to participate or play the role of an active patient. The findings in this paper contribute to the growing literature on patient-centred healthcare by empirically investigating how the discursive configuration of patient, health professional and institutional practices intertwine in producing certain inherent expectations, habits and taken for granted perspectives in care delivery. I also suggest that the findings can usefully be incorporated into patient-centred care design and organizational strategies in order to take into account both the patient, relatives and healthcare professionals as vital for creating a patient-centred practice, organization and professional environment.


Miles A, Mezzich J. The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. Int J Pers Cent Med 2011;1:207–22. DOI: https://doi.org/10.5750/ijpcm.v1i2.61

Starfield B. Is patient-centered care the same as person-focused care? Perm J 2011;15:63–9. DOI: https://doi.org/10.7812/TPP/10-148

Mjølstad BP, Luise Kirkengen A, Getz L, Hetlevik I. Standardization meets stories: Contrasting perspectives on the needs of frail individuals at a rehabilitation unit. Int J Qual Stud Health Well-being 2013;8. DOI: https://doi.org/10.3402/qhw.v8i0.21498

Lord L, Gale N. Subjective experience or objective process: understanding the gap between values and practice for involving patients in designing patient-centred care. J Health Organ Manag 2014;28:714–30. DOI: https://doi.org/10.1108/JHOM-08-2013-0160

Leplege A, Gzil F, Cammelli M, et al. Person-centredness: Conceptual and historical perspectives. Disabil Rehabil 2007;29:1555–65. DOI: https://doi.org/10.1080/09638280701618661

Baxter LA. Voicing relationships, a dialogic perspective. Los Angeles, CA: Sage; 2011. DOI: https://doi.org/10.4135/9781452230344

Baxter LA, Suter EA, Thomas LJ, Seurer LM. The dialogic construction of “adoption” in online foster adoption narrative...: EBSCOhost. J Fam Commun 2015;15:193–213. DOI: https://doi.org/10.1080/15267431.2015.1043431

Phillips LJ. The promise of dialogue, the dialogic turn in the production and communication of knowledge. Amsterdam: John Benjamins; 2011. DOI: https://doi.org/10.1075/ds.12

Renedo A, Marston C. Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement. BMC Health Serv Res 2015;15:122. DOI: https://doi.org/10.1186/s12913-015-0770-y

Pedersen AR. The role of patient narratives in healthcare innovation: supporting translation and meaning making. J Health Organ Manag 2016;30:244–57. DOI: https://doi.org/10.1108/JHOM-01-2015-0007

Borgermans L, Marchal Y, Busetto L, et al. How to improve integrated care for people with chronic conditions: key findings from EU FP-7 Project INTEGRATE and beyond. Int J Integr Care 2017;17. DOI: https://doi.org/10.5334/ijic.3096

Borgermans L, Devroey D. A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond. Int J Integr Care 2017;17. DOI: https://doi.org/10.5334/ijic.3295

Vrangbaek K. Patient involvement in Danish health care. J Health Organ Manag 2015;29:611-24. DOI: https://doi.org/10.1108/JHOM-01-2015-0002

Dent M, Pahor M. Patient involvement in Europe – a comparative framework. J Health Organ Manag 2015;29:546–55. DOI: https://doi.org/10.1108/JHOM-05-2015-0078

Pedersen KZ, Kjær P. “The new patient”: the emergence of a political persona. Int J Public Sect Manag 2017;30:85–98. DOI: https://doi.org/10.1108/IJPSM-04-2016-0081

Apker J. Communication in health organizations. Cambridge: Polity Press; 2012. 271 p.

Abreu BC, Zhang L, Seale G, et al. Brain Injury Interdisciplinary meetings: investigating the collaboration between persons with brain injury and treatment teams. 2002; Available from: http://www.tandfonline.com/action/journalInformation?journalCode=ibij20 Accessed 2018 Dec 10.

Ledderer L. Bringing about change in patient-centred preventive care. Int J Public Sect Manag 2010;23:403–12. DOI: https://doi.org/10.1108/09513551011047297

McDermott AM, Pedersen AR. Conceptions of patients and their roles in healthcare. In: M McDermott, AR Pedersen, eds. J Health Organ Manag 2016;30:194–206.

Lawrence M, Kinn S. Defining and measuring patient-centred care: An example from a mixed-methods systematic review of the stroke literature. Heal Expect 2012;15:295–326. DOI: https://doi.org/10.1111/j.1369-7625.2011.00683.x

Alby F, Fatigante M, Zucchermaglio C. Managing risk and patient involvement in choosing treatment for cancer: an analysis of two communication practices. Sociol Health Illn 2017;39:1427–47. DOI: https://doi.org/10.1111/1467-9566.12598

Rosewilliam S, Roskell CA, Pandyan A. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501–14. DOI: https://doi.org/10.1177/0269215510394467

Falk K, Ung EJ, Östman M. Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure - A grounded theory study. Int J Qual Stud Health Well-being 2015;10. DOI: https://doi.org/10.3402/qhw.v10.27775

Marks D. Models of disability. Disabil Rehabil 1997;19:85–91. DOI: https://doi.org/10.3109/09638289709166831

Kontos PC, Miller K-L, Gilbert JE, et al. Improving Client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612–32. DOI: https://doi.org/10.1177/1049732312458370

Pors AS. Constructions of the patient in healthcare communications: six patient figures. J Health Organ Manag 2016;30:279–98. DOI: https://doi.org/10.1108/JHOM-12-2014-0216

Frank AW. Just listening: Narrative and deep illness. Fam Syst Heal 1998;16:197–212. DOI: https://doi.org/10.1037/h0089849

Humle DM, Pedersen AR. Fragmented work stories: Developing an antenarrative approach by discontinuity, tensions and editing. Manag Learn 2015;46:582–97. DOI: https://doi.org/10.1177/1350507614553547

Davenport NHM. Medical residents’ use of narrative templates in storytelling and diagnosis. Soc Sci Med 2011;73:873. DOI: https://doi.org/10.1016/j.socscimed.2011.01.036

Charon R. Narrative medicine: attention, representation, affiliation. Narrative 2005;13:261–70. DOI: https://doi.org/10.1353/nar.2005.0017

Overcash JA. Narrative research: a review of methodology and relevance to clinical practice. Crit Rev Oncol Hematol 2003;48:179–84. DOI: https://doi.org/10.1016/j.critrevonc.2003.04.006

Bakhtin MM. Problems of Dostoevsky’s poetics. Bakhtin In: Mikhail Mikhaĭlovich MM, Emerson C, (Firm) P, eds. Minneapolis: University of Minnesota Press; 1984.

Bakhtin MM. Dialogic imagination: four essays. Holquist M, ed. Austin: Austin, TX, USA: University of Texas Press; 1981.

Balbale SN, Turcios S, LaVela SL. Health care employee perceptions of patient-centered care. Qual Health Res 2015;25:417–25. DOI: https://doi.org/10.1177/1049732314553011

Phillips L, Napan K. What’s in the “co”? Tending the tensions in co-creative inquiry in social work education. Int J Qual Stud Educ 2016;29:827–44. DOI: https://doi.org/10.1080/09518398.2016.1162869

Soffer M, Chew F. Framing disability among young adults with disabilities and non-disabled young adults: an exploratory study. Disabil Rehabil 2015;37:171–8. DOI: https://doi.org/10.3109/09638288.2014.913701

Kristiansen M, Bloch-Poulsen J. Participation as enactment of power in dialogic organisational action research. Reflections on Conflicting Interests and Actionability Zur Verfügung gestellt in Kooperation mit/provided in cooperation with. Int J Action Res 2011;7:347–80.

Charon R. At the membranes of care: stories in narrative medicine. Acad Med 2012;87:342–7. DOI: https://doi.org/10.1097/ACM.0b013e3182446fbb

Barge JK, Little M. Dialogical wisdom, communicative practice, and organizational life. Commun Theory 2002;12:375–97. DOI: https://doi.org/10.1111/j.1468-2885.2002.tb00275.x

Delmar C. "Generalizability" as recognition: reflections on a foundational problem in qualitative research. Qual Stud 2010;1:115–28. DOI: https://doi.org/10.7146/qs.v1i2.3828

Sundhedsstyrelsen. Kommissorium for servicetjek af genoptrænings- og rehabiliteringsindsatserne for personer med erhvervet hjerneskade. 2017;2014. Available from: http://www.sum.dk/Aktuelt/Nyheder/Kommunale_sundhedsopgaver/2017/Februar/~/media/Filer-dokumenter/Kom-servicetjek-hjerneskadeomraadet.ashxstudie

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Region of Zealand, Denmark

Uhre, Jannie. 2018. “The Dialogic Construction of Patient Involvement in Patient-Centred Neurorehabilitation”. Qualitative Research in Medicine and Healthcare 2 (3). https://doi.org/10.4081/qrmh.2018.7792.

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