Communicating stroke survivors' health and further needs for support in care-planning meetings.

AIMS AND OBJECTIVES: This study will illustrate how stroke survivors, their relatives and different professionals communicated in care-planning meetings when planning care for patients after their discharge from hospital. We wanted to know what topics participants were talking about, to what extent they were involved in the discussion and how the communication was organized.

BACKGROUND: Communication in health care is sometimes problematic because of the participants' asymmetrical positions when negotiating how to understand the patients' future care.

METHODS: A qualitative and a quantitative design were adopted with a sample of 14 authentic audio-recorded care-planning meetings. The transcribed meetings were, together with observational notes, analysed from a data-driven approach.

FINDINGS: Five topics emerged. The professionals tended to dominate the discourse space even if their involvement varied depending on the topic talked about. The most noteworthy finding was the patients' need of communicative alliances with other participants when negotiating their needs and desires of further care. When making decisions two approaches emerged. The 'aim-driven' approach was characterized by alliances between those participants who seemed to share a common goal for the patient's further care. When the participants used the 'open-minded' approach they merged information and discussed different solutions leading to a goal step by step.

CONCLUSIONS: The importance of strengthening stroke survivors' participation in care-planning meetings is highlighted. Professionals have to increase their knowledge about how to involve the patients as well as their awareness of how to avoid power struggles between various professionals, patients and relatives. Relevance to clinical practice. This study shows the necessity for professionals to involve relatives when negotiating these patients' need of further care and to learn more about how to advocate stroke survivors.