Risk management after stroke: The limits of a patient-centred approach

Abstract

Current strategies to reduce risk of stroke recurrence are reported to be inadequate. This paper reports findings from a qualitative observational study investigating how risk management is practiced in the stroke outpatient clinic. The ‘patient-centred’ approach has been proposed as a mechanism to improve the quality of health care delivery. It is thought that focusing on patients' wants, needs and preferences is ethically desirable and will lead to improved health outcomes. However risk management strategies are delivered within the broad social and structural limitations of healthcare. Little is known about how these processes influence a patient-centred approach to secondary prevention delivery. This study identified three important influences: medical authority, and its constraints on communication within consultation settings; structural barriers relating to service organization; and expectations of the patient role. Medical authority influenced patients' attempts to voice their concerns and participate in decision-making, and professionals' attempts to focus on patients' priorities. Service structures influenced continuity in service provision and limited professionals' ability to attend to patients' psychosocial concerns. This study raises questions about definitions of patient-centred care and methods for achieving patient-centredness, and highlights tensions between a patient-centred approach and public health goals for risk management.