‘As Good as it's Going to Get’. Bad News Conversations in Neurology: Challenges for Occupational Therapists

Abstract

Introduction: This exploratory study sought to answer the question, ‘What are the experiences of neurological occupational therapists when having bad news conversations with disabled people regarding likely levels of long-term disability?’. Method: The study design was a retrospective qualitative method within a phenomenological methodology. Convenience sampling was used to identify occupational therapists working with neurologically impaired adults. Ten semi-structured interviews using a topic guide were conducted. Ethical approval was granted by the Faculty Research Ethics Committee. Findings: Participants had bad news conversations prior to discharge and there was a functional focus. Four approaches to these conversations emerged: collaboration, being direct, avoidance and using a client-centred approach. Strategies included use of pre-discharge home visit, goal setting, using others, maintaining hope and communication skills. The participants agreed that this task has an emotional cost. Conclusion: Bad news conversations are an important and sometimes difficult clinical task that can have an impact on the quality of the therapeutic relationship. Little has been documented regarding occupational therapists' conversations relating to living with long-term disability. This study has underlined the importance of addressing this task in undergraduate education and also in the supervision of junior occupational therapists.