How Hospitalized Older Adults and Physicians Negotiate Plan-of-Care Decisions during Daily Rounds

ABSTRACT

The purpose of this study is to explore how older adults and physicians negotiate the plan of care during daily rounds in the hospital setting. We audio-recorded 40 physician–patient interactions during daily rounds in a small teaching hospital. We analyzed the data using conversation analysis, a qualitative method that examines the turns-of-talk during interactions. We focused the analysis on how physicians introduced the plan of care and how the plan of care was subsequently negotiated with the patient. Physicians often introduced the plan in two different ways that have a persuasive design: leading with evidence and medical expertise or, for sensitive topics in which the plan could be disagreeable, using preplan sequences to delicately introduce the plan of care and assess patient response. Patients negotiated the plan of care by displaying resistance, both passively and actively. Despite patients sharing their evidence for their preferred plan of care in resisting the physician’s plan, physicians often closed the negotiation by reorienting to a different aspect of the plan of care.

Disclosure of potential conflict of interest

We have no conflict of interest to declare.

Additional information

Funding

This work was supported by a 2017 Research Committee Award from the School of Nursing, University of Wisconsin-Madison. This work was supported in part by the VA Advanced Fellowship in Women’s Health. This material is the result of the work supported with resources and the use of facilities at the William S. Middleton Memorial Veterans Hospital. The contents do not represent views of the Department of Veterans Affairs or the United States Government.