Discharge planning:: 'fooling ourselves'?: patient participation in conferences

Background. The aim of discharge planning conferences (DPCs) is to co-ordinate resources and to enhance patient involvement in care in connection with relocation from hospital. DPCs can be characterized as institutional conversations, and are often executed as standard procedures, but the scientific basis for the activity is weak. Aims and objectives. The aim of this study was to illuminate and describe the communication at DPCs. Design. A purposeful and consecutive sample of eight DPCs was collected in which the future care of eight women, aged 70 years or more, was discussed. Methods. Transcribed video recordings were analysed in two steps. 'The initial analysis' aimed at describing the structure and content of the communication. This description constituted the basis for an interpretation, leading to 'the focused analysis' aiming at finding evidence for the assumptions made in the interpretation. Results. The result revealed that the participation of patients was very less the DPCs. The decisions had often already been made, and the women were expected to be pleased with the decision; institutional representatives (IRs) frequently justified their actions by referring to bureaucratic praxis. Conclusions. The women were both encouraged and excluded from participation by the IRs. This dichotomy occurred because the IRs, as professionals, struggled to simultaneously realize their caring mission and their obligation to enforce the values and rules of the institution, i.e. efficiency and rationality. Thus, IRs and patients were equally imprisoned within the institutional system. Relevance to clinical research. This result illustrates how conflicting paradigms are imbedded and reproduced by healthcare professionals in their communicative praxis. Awareness of this is a prerequisite for improvements in working procedures congruent with a caring paradigm that support patient participation.