Communication Among Interprofessional Teams Treating Patients With Disorders of Consciousness After Brain Injury

PURPOSE: The purpose of this study was to understand how clinicians who work with patients with disorders of consciousness (DoC) after traumatic brain injury (TBI) communicate about patients’ behaviors related to improvement, deterioration, and plateau. Communication and collaboration among interprofessional clinicians is central to providing person-centered care and to conveying patients’ progress to caregivers and other clinicians because these patients are unable to relay this information (Papadimitriou & Cott, 2015).

METHOD: A grounded theory approach was used to understand communication between clinicians and between clinicians and caregivers when describing patients’ behaviors. Clinicians with experience working with patients with DoC after TBI were recruited from three hospital systems. Clinicians included occupational therapists, social workers, physical therapists, speech-language pathologists, and physicians. Twenty-one clinicians participated in one-on-one semistructured interviews. Interviews were audio recorded and transcribed verbatim.

NVivo 11 Plus software (QSR International, Melbourne, Australia) was used for line-by-line open coding and to record coders’ personal notes. Personal notes provide insight into how coders’ thoughts and ideas evolve during their time reading and coding the data (Green & Thorogood, 2014). Two members of the team reviewed and independently coded all data. The codes were reviewed with two other members of the team who had recruited and interviewed the clinicians (Papadimitriou et al., 2017). The team developed a codebook using thematic analysis and constant comparative strategies to finalize the codebook (Glaser, 1965; Green & Thorogood, 2014).

RESULTS: Emerging themes were organized in terms of understanding what communication tools or strategies clinicians used, how they perceived their communication exchanges, and what challenges they experienced when interacting with each other and with caregivers. Clinicians talked about the difficulty of interpreting patients’ behaviors during an assessment, being confident when selecting a treatment, and leveraging caregivers’ interpretation of patients’ behavior.

The data offer rich descriptions of the challenges clinical teams face in communicating to and about patients with DoC. For example, one clinician described the challenge faced when explaining to other clinicians that a caregiver’s advocacy for the patient was being misinterpreted as not understanding the patient’s current needs. The clinician tried to convey that the caregiver was equipped to take the patient home: “I was turning blue in the face communicating to the team that I did strongly feel that [the caregiver] had a reasonable expectation and an understanding of the severity of his deficit.”

CONCLUSION: This qualitative analysis explores the unique challenges clinicians face in communicating with team members when treating complex patients with DoC after TBI in inpatient rehabilitation. These communication challenges were grounded in the uncertainty of the therapeutic and prognostic context of treating this patient population. Uncertainty arises from not knowing the patient’s prognosis, evidence supporting specific interventions, and discharge planning. Thus, when patients demonstrate improvement or a plateau, clinicians are challenged to explain what this change means for the patient’s recovery.

IMPACT STATEMENT: Uncovering how clinicians make sense of patients’ behaviors and how clinicians communicate these behaviors can aid in creating a foundation for improving the exchange of information.

References

Glaser, B. G. (1965). The constant comparative method of qualitative analysis. Social Problems, 12, 436–445. https://doi.org/10.2307/798843

Green, J., & Thorogood, N. (2014). Part III: Managing and analysing data. In Qualitative methods for health research (pp. 201–254). London: Sage.

Papadimitriou, C., & Cott, C. (2015). Client-centred practices and work in inpatient rehabilitation teams: Results from four case studies. Disability and Rehabilitation, 37, 1135–1143. https://doi.org/10.3109/09638288.2014.955138

Papadimitriou, C., Mallinson, T., Pape, T., Guernon, A., Weaver, J., & Walsh, E. (2017). Identifying exemplars of meaningful functional change seen in patients with disorders of consciousness following severe traumatic brain injury [Abstract]. Brain Injury, 31, 947. https://doi.org/10.1080/02699052.2017.1312145