Talking about recovery after stroke: How do we do it, and how can we do better?

This project aimed to understand how recovery is currently discussed in stroke units and how patients, carers and staff experience providing and receiving it, to inform development of a complex intervention.

We explored current practice using focused ethnographic case study methods in two stroke units. We conducted non-participant observations of opportunities for conversations about recovery, and interviewed patients, carers and stroke unit professionals. We also analysed relevant documents, including patients records and unit policies. We systematically reviewed the literature to identify and synthesised existing studies relating to patients’, carers’ and professionals’ views and experiences, and the effectiveness of existing strategies to improve provision. We then used the Behaviour Change Wheel to begin development of an intervention to improve the provision of information about recovery by stroke unit staff to patients and their families. Finally, we conducted an online survey of stroke professionals, to gather their feedback on the proposed intervention strategies

A complex range of factors impacted the consistency, quality, and delivery of information about recovery on stroke units. These included the hospital and stroke unit environment, how the multidisciplinary team worked together to plan and provide information, the uncertainties of stroke recovery, and individual differences in patients’ and carers’ abilities and needs. Patients and carers described mixed experiences of receiving information. They wanted staff to be proactive in discussing the subject of recovery with them and wanted information to be provided honestly and with positivity and compassion. Some professionals felt they lacked the skills and confidence to discuss recovery, and that they didn’t have enough knowledge of the benefits of doing so. We were unable to identify any existing interventions to improve provision of information about recovery in neurological conditions from existing literature. Professionals perceived that receiving practical advice and demonstrations of communication skills, as well as MDT support would help to address the barriers they faced in discussing recovery.

Since completing this work, we have received further funding to continue development of our intervention, working alongside stroke survivors, carers and staff to design materials and implementation plans (the FORECAST study: https://ageingstrokeresearch.org/research-projects/development-of-an-intervention-to-improve-provision-of-information-about-recovery-on-the-stroke-unit/).

Investigators

Clarke D, Forster A, Tyson S, Burton L.

Lead Researcher:
Louisa-Jane Burton

Academic Supervisors:
Dr David Clarke
Dr Judith Johnson
Dr Tom Crocker
Prof Anne Forster

01/09/2017 – 31/03/2021

The Stroke Association’s Postgraduate Fellowship Scheme

(ref:  TSA PGF 2017-02)

For further information contact please visit:  https://www.stroke.org.uk/research/how-can-we-improve-talking-about-recovery-stroke-unit

Or contact: Louisa Burton