Managing Communication Challenges in Recommending Aids and Adaptations to Activities of Daily Living in Physiotherapy...

Often, occupational and physiotherapeutic assessment consultations involve patients discussing their problems in activities of daily living (ADL) and therapists trying to find suitable solutions. These conversations can present challenges since patients frequently reject therapists' recommendations, which can jeopardize shared decision-making, bring interactional and relational tensions, and can mean patients can lose out on potential benefit. This study, in a palliative care setting, is aimed at improving our understanding of how therapists handle these communicative challenges. Based on audio/video-recordings of assessment consultations at an English hospice, we used conversation analysis to examine specialist therapists' recurrent practices for introducing recommendations and responding to patient resistance, and whether/how these enacted shared decision-making. We identified seven practices through which therapists introduced interventions, each did so cautiously, in ways that seemed to head-off or mitigate potential rejection. And we identified seven practices through which therapists responded to resistance, for example, by accepting it or moving on, or by working to sustain the potential intervention as a live matter and potentially beneficial in the future. While a subset of these practices seem restricted to the palliative care setting-namely, those which implicate future deterioration-we suggest that most are applicable across settings in which ADL recommendations are given. These findings fill a gap in practical guidance regarding ADL recommendations in this therapeutic environment, and more generally contribute to our understanding of resistance to advice and suggestions in clinical settings.