TY - JOUR

T1 - ‘The way you talk, do I have a choice?’

T2 - Patient narratives of medication decision-making during hospitalization

AU - Rognan, Stine Eidhammer

AU - Jørgensen, Mie Jedig

AU - Mathiesen, Liv

AU - Druedahl, Louise Christine

AU - Lie, Helene Berg

AU - Bengtsson, Kajsa

AU - Andersson, Yvonne

AU - Sporrong, Sofia Kälvemark

N1 - Publisher Copyright: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

PY - 2023

Y1 - 2023

N2 - Objective: Based on the principle of the autonomy of the patient, shared decision-making (SDM) is the ideal approach in clinical encounters. In SDM, patients and healthcare professionals (HCPs) share knowledge and power when faced with the task of making decisions. However, patients are often not involved in the decision-making process. In this study, we explore medication decision-making during hospitalization and how power in the specific patient—HCP relationship is articulated, as analysed by Foucauldian theory. Methods: A qualitative case study, comprising observations of patient-HCP encounters at an internal medicines ward at a university hospital in Norway, followed by semi-structured interviews. The narratives (n = 4 patients) were selected from a larger study (n = 15 patients). The rationale behind the choice of these patients was to include diverse and rich accounts. The four patients in their 40s–70s were included close to the day of presumed discharge. Results: The narratives provide an insight into the patients as persons, their perspectives, including what mattered to them during their hospitalization, especially in relation to medications. Overall, SDM was not observed in this study. Even though all the participants actively tried to keep their autonomous capacity and to resist the HCPs’ use of power, they were not able to change the established dynamics. Moreover, they were not allowed an equal voice to those of HCPs and thus not to escape the system’s objectification and subjectification of them. Conclusion: There is a need for HCPs to get more familiarized with SDM. The healthcare system and the individual HCP need to make more room for dialogue with the patients about their preferences. A part of this is also how health care systems are structured and scheduled, thus, it is important to empower patients and HCPs alike.

AB - Objective: Based on the principle of the autonomy of the patient, shared decision-making (SDM) is the ideal approach in clinical encounters. In SDM, patients and healthcare professionals (HCPs) share knowledge and power when faced with the task of making decisions. However, patients are often not involved in the decision-making process. In this study, we explore medication decision-making during hospitalization and how power in the specific patient—HCP relationship is articulated, as analysed by Foucauldian theory. Methods: A qualitative case study, comprising observations of patient-HCP encounters at an internal medicines ward at a university hospital in Norway, followed by semi-structured interviews. The narratives (n = 4 patients) were selected from a larger study (n = 15 patients). The rationale behind the choice of these patients was to include diverse and rich accounts. The four patients in their 40s–70s were included close to the day of presumed discharge. Results: The narratives provide an insight into the patients as persons, their perspectives, including what mattered to them during their hospitalization, especially in relation to medications. Overall, SDM was not observed in this study. Even though all the participants actively tried to keep their autonomous capacity and to resist the HCPs’ use of power, they were not able to change the established dynamics. Moreover, they were not allowed an equal voice to those of HCPs and thus not to escape the system’s objectification and subjectification of them. Conclusion: There is a need for HCPs to get more familiarized with SDM. The healthcare system and the individual HCP need to make more room for dialogue with the patients about their preferences. A part of this is also how health care systems are structured and scheduled, thus, it is important to empower patients and HCPs alike.

KW - Foucault

KW - Hospital discharge

KW - medication communication

KW - patient perspective

KW - shared decision making

U2 - 10.1080/17482631.2023.2250084

DO - 10.1080/17482631.2023.2250084

M3 - Journal article

C2 - 37615270

AN - SCOPUS:85168570054

VL - 18

JO - International Journal of Qualitative Studies on Health and Well-being

JF - International Journal of Qualitative Studies on Health and Well-being

SN - 1748-2623

IS - 1

M1 - 2250084

ER -