title: Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: a mixed methods study.
abstract: BACKGROUND
  Limited negotiation around care decisions is believed to undermine collaborative working between parents of children with long-term conditions and professionals, but there is little evidence of how they actually negotiate their respective roles. Using chronic kidney disease as an exemplar this paper reports on a multi-method study of social interaction between multidisciplinary teams and parents as they shared clinical care.
  
  
  METHODS
  Phases 1 and 2: a telephone survey mapping multidisciplinary teams' parent-educative activities, and qualitative interviews with 112 professionals (Clinical-psychologists, Dietitians, Doctors, Nurses, Play-specialists, Pharmacists, Therapists and Social-workers) exploring their accounts of parent-teaching in the 12 British children's kidney units. Phase 3: six ethnographic case studies in two units involving observations of professional/parent interactions during shared-care, and individual interviews. We used an analytical framework based on concepts drawn from Communities of Practice and Activity Theory.
  
  
  RESULTS
  Professionals spoke of the challenge of explaining to each other how they are aware of parents' understanding of clinical knowledge, and described three patterns of parent-educative activity that were common across MDTs: Engaging parents in shared practice; Knowledge exchange and role negotiation, and Promoting common ground. Over time, professionals had developed a shared repertoire of tools to support their negotiations with parents that helped them accomplish common ground during the practice of shared-care. We observed mutual engagement between professionals and parents where a common understanding of the joint enterprise of clinical caring was negotiated.
  
  
  CONCLUSIONS
  For professionals, making implicit knowledge explicit is important as it can provide them with a language through which to articulate more clearly to each other what is the basis of their intuition-based hunches about parents' support needs, and may help them to negotiate with parents and accelerate parents' learning about shared caring. Our methodology and results are potentially transferrable to shared management of other conditions.
authors.affiliation: School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK. veronica.swallow@manchester.ac.uk
authors.forename: Veronica M
authors.initials: VM
authors.lastname: Swallow
authors.forename: Ruth
authors.initials: R
authors.lastname: Nightingale
authors.forename: Julian
authors.initials: J
authors.lastname: Williams
authors.forename: Heather
authors.initials: H
authors.lastname: Lambert
authors.forename: Nicholas J A
authors.initials: NJ
authors.lastname: Webb
authors.forename: Trish
authors.initials: T
authors.lastname: Smith
authors.forename: Lucy
authors.initials: L
authors.lastname: Wirz
authors.forename: Leila
authors.initials: L
authors.lastname: Qizalbash
authors.forename: Laura
authors.initials: L
authors.lastname: Crowther
authors.forename: Davina
authors.initials: D
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D017008:Negotiating; D010348:Patient Care Team; D011368:Professional-Family Relations; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D006113:United Kingdom