Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: towards a theory of authentic caring in clinical relationships.
OBJECTIVE
We developed a method whereby relationships can be studied simultaneously from the perspectives of each party and researchers' observations of their dialogue. Then we used this method to study how to recognise authentic, caring clinical relationships.


METHODS
Participants were 20 patients who had recently received surgery for breast cancer and nine surgeons with whom they had a post-operative consultation. We audiorecorded consultations, before interviewing patients and surgeons about their perceptions of the consultation and each other. Cross-case qualitative analyses (analysing consultations and surgeon and patient interviews, respectively) were supplemented by integrative, within-case analysis.


RESULTS
Surgeons and patients described their relationship as personal and emotional, but emotional talk was absent from consultations. For patients and surgeons, their relationship depended, instead, on surgeons' expertise and character.


CONCLUSIONS
Our integrative approach suggested that authentic caring in these relationships lay in practitioners' conscientious execution of their role and, contrary to currently influential views, not in an explicit emotional engagement.


CONCLUSIONS
Relationships between patients and practitioners cannot be described adequately using analyses of interactions between them. Researchers will need to triangulate between these observations and the patient and practitioner perspectives in order to understand what makes for authentically caring relationships.
University of Liverpool, Division of Clinical Psychology, and Royal Liverpool University Hospital, Liverpool, UK. psalmon@liv.ac.uk
Peter
P
Salmon
Nicola
N
Mendick
Bridget
B
Young
D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery; D003142:Communication; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians; D011184:Postoperative Period; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013637:Tape Recording