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RESEARCH AND
THEORY
Understanding the
Professional Care
Experience of Patients with
Stroke: A Qualitative Study
Using In-Depth Interviews
BELEN MARTIN-SANZ
ROSA MARÍA SALAZAR-DE-LA-GUERRA
JUAN NICOLAS CUENCA-ZALDIVAR
ANA MARÍA AGUILA-MATURANA
CRISTINA GARCIA-BRAVO
MARÍA SALCEDO-PEREZ-JUANA
ESTER CAPIO-CALATAYUD
DOMINGO PALACIOS-CEÑA
ABSTRACT
Background: Professional support and communication stimulates the professional-
patient relationship and supports the recovery of stroke patients.
Objectives: To describe the perspectives of patients with stroke regarding
communication, professional support, and their ability to participate in processes and
integrated care with health providers.
Methods: A qualitative study was conducted. A purposeful sampling and snowball-
technique were used. Patients diagnosed with moderate or severe stroke in the post-
acute or chronic stage of the disease were included. Data collection consisted of in-
depth interviews and researcher field notes. A thematic analysis was performed.
Results: Thirty-one patients were included. Three themes were identified: 1) Providing
support, with four categories, professional behavior, personalized attention, the heart
of the professional and building a bond with the patient; 2) Facilitating communication,
with three categories, the patient as the recipient, the content of the message and
the channel, and the professional as the person that conveys the message; and 3)
Promoting participation, with two categories, barriers, and incentives to participate.
Conclusions: When providing support, professionals should consider communicating
information and encouraging the participation of stroke patients for integrated care.
CORRESPONDING AUTHOR:
Belen Martin-Sanz
Research Group of Humanities
and Qualitative Research
in Health Science of
Universidad Rey Juan Carlos
(Hum&QRinHS), ES
belen.martin@urjc.es
KEYWORDS:
(MeSH): stroke; professional-
patient relations; therapeutic
alliance; stroke rehabilitation;
integrated care; qualitative
research
TO CITE THIS ARTICLE:
Martin-Sanz B, Salazar-de-la-
Guerra RM, Cuenca-Zaldivar JN,
Aguila-Maturana AM, Garcia-
Bravo C, Salcedo-Perez-Juana
M, Capio-Calatayud E, Palacios-
Ceña D. Understanding
the Professional Care
Experience of Patients with
Stroke: A Qualitative Study
Using In-Depth Interviews.
International Journal of
Integrated Care, 2022; 22(4):
2, 1–11. DOI: https://doi.
org/10.5334/ijic.6526
*Author affiliations can be found in the back matter of this article
2Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
INTRODUCTION
Stroke is the third leading cause of death worldwide and
is a major cause of disability [1]. In Spain, according to
the report by the Spanish Society of Neurology, entitled
“the Atlas of stroke Spain 2019” [2] about 110,000
people suffer a stroke each year, of whom at least 15
percent will die and, among the survivors, 30 percent will
present disability and functional dependence. This report
[2] predicts that these figures will continue to increase
by 39% between 2015 and 2035. The quality of care
of people with stroke must be guaranteed, and greater
clinical effectiveness and patient satisfaction must be
achieved for integrated care [3, 4]. Integrated care of
the stroke patient should be based on collaborative
engagement and cooperation between patients and
caregivers to align health care services resulting in
effective clinical stroke care management [5]. It is
necessary to favor the implementation of this integrated
care in stroke patients by facilitating the management
of patient preferences in the care process [6], requiring
rigorous evaluation in this population through training
and patient empowerment of their health care [7].
The patient’s perspective on their health care affects
adherence to treatment or the reduction of complaints
and is considered a proxy indicator of care [8].
The relationship between professionals and patients
is considered a relevant element in the quality of health
services [3, 4]. The professional-patient relationship
is defined as the set of guidelines and behaviors that
are established in the clinical encounter, as well as the
significant therapeutic interactions shared with patients
and healthcare professionals [9]. This type of relationship
is valued above technical skills and can influence a
healthcare professional’s recommendations [10]. In
addition, patients positively value the existence of the
professional’s interpersonal care. This care consists of
treating patients, including affective behaviors, and
communication management skills, and facilitating
patient participation in decisions [11].
Within the professional-patient relationship,
professional support strengthens the relationship and
increases patient satisfaction [4, 11]. This support can
take different forms such as professional kindness,
warmth, active listening, consolation, forgiveness, or
acceptance of behaviors [4]. In addition, the assessment
of how the patient wants to be treated according to their
disease, culture, ethnicity, age, etc., is also included [12].
Moreover, communication is another element in the
professional-patient relationship [13], which facilitates
treatment efficacy [14] and improves patient satisfaction
[15]. In the case of stroke patients, communication
between trained professionals and patients promotes
shared decision making and prevents ethical conflicts
[16]. Finally, the participation of patients facilitates their
adherence to treatment, improves the perceived quality
of care, and facilitates shared decision making with
professionals [17].
It is necessary to explore what stroke patients expect
from the support of health professionals, what it means
for them to receive professional support, how the
communication process is carried out, and how decision
making between the professional and the patient
is carried out. In this manner, essential information
may be obtained for professionals to use in their daily
clinical work of integrated care with stroke patients.
Thus, the objective of this study was: to describe the
perspectives of patients with stroke regarding the
communication, professional support, and participation
of patients with health providers.
METHODS
STUDY DESIGN
A qualitative descriptive study was conducted [18]. The
aim of a descriptive qualitative study is to identify an
event and describe “what is happening” and “how it
is happening” [19, 20]. Qualitative descriptive studies
aim to be a comprehensive summary of events in
the everyday terms of the described event [21, 22].
Qualitative research is useful for describing complex
phenomena and understanding the beliefs, values, and
motivations that underlie individual health behaviors
[18, 23]. Furthermore, qualitative studies have been
used to research the stroke survivors’ experiences and
expectations before and after treatment [24], and the
patient’s participation in their recovery process [25].
The Standards for Reporting Qualitative Research (SRQR)
were used [26].
THEORETICAL FRAMEWORK
The theoretical framework that guided this study was
interpretivist [18]. From an interpretive perspective,
human action is meaningful, and the goal of inquiry is
understanding how people respond and understand the
meaning of social phenomena [27].
RESEARCH TEAM
Eight researchers were involved in this study (six women,
two men), of which four had experience in qualitative
designs (DPC, BMS, CGB, MSPJ). Three hold PhDs in health
sciences (AMAM, DPC, JNCZ), and were not involved in
clinical activity. Three members of the research team
worked in the rehabilitation context (BMS, AMAM, ECC).
SETTING AND SAMPLE
A non-probabilistic, purposeful sampling and snowball-
technique strategy were used in the present study,
based on relevance to the research question rather
than representativeness [18, 28]. A purposeful sampling
strategy involved deliberately selecting participants [18].
Also, a snowball sampling procedure was applied, in the
3Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
case of participants who put the researcher in touch with
other participants in similar circumstances and who met
the inclusion criteria.
The inclusion criteria were: a) patients > 18 years, b)
with moderate or severe stroke diagnosed by a doctor
according to the National Institutes of Health Stroke
Scale (NIHSS) [29], c) in the post-acute or chronic stage.
The exclusion criteria were: a) patients with cognitive
decline, and/or with alterations in verbal communication,
b) patients with mild stroke according to the NIHSS Scale,
and c) in the acute stage. Participants were recruited
from two stroke rehabilitations centers.
In qualitative research, there is no formula for the prior
calculation of the sample size, since the results are not
intended to be representative and generalizable [18, 28].
In the current study, the sample size was determined
following the proposal by Turner-Bowker et al [30]. These
authors reported that 99.3% of concepts, themes, and
contents emerged with around 30–35 interviews [30].
With this proposal, a greater capacity to identify codes,
categories, and topics is achieved.
DATA COLLECTION
In-depth interviews and researcher’s field notes were
used as the main tool for data collection [18, 28]. With
participants 1–5, the interview started with an open
question: “Please, can you share your personal experience
with me regarding stroke and the communication process,
professional support and patient participation during
your rehabilitation and recovery process?” Thereafter, the
researchers noted the key words and topics identified in
the patients’ responses and used their answers to ask for
them to clarify the content [18, 28]. A first analysis was
performed on the unstructured interviews of participants
1–5. This analysis revealed some relevant topics that
required further study, thus making it necessary to
include a second stage of data collection. The second
stage (participants 6–31) consisted of semi-structured
interviews that were based on a question guide designed
to gather information regarding specific topics of interest
(Table 1). The semi-structured question guide did not
follow a fixed order of questions. The interviewer and
the participants could start or continue with different
questions that probed different areas of research.
The interviews were audio-recorded and transcribed
verbatim. Overall, 1273 min of data collection were
recorded, with a mean of 41 min (SD 15.8). All
interviews were held at stroke rehabilitations centers.
We used researcher field notes as a secondary source of
information to provide more in-depth information [28]. In
addition, field notes provide a rich source of information
as participants describe their personal experiences and
their behaviors during data collection.
DATA ANALYSIS
An inductive thematic analysis was used on the
interviews to identify the relevant themes obtained
from the interviews [28, 31]. Full transcripts were made
of each in-depth interview and of the researchers’ field
notes [28, 31]. Thematic analysis consisted of identifying
text fragments with relevant information to answer
the research question [28, 31]. From these narratives,
the most descriptive contents (codes) were identified.
Subsequently, these units were grouped by their
common meaning (categories) and/or similar content
[28, 31]. Thematic analysis was applied separately
to interviews and field notes by BMS, and DPC. Joint
team meetings were held to combine the results of
the analysis and discuss data collection and analysis
procedures. In these team meetings the final themes
were displayed, combined, integrated, and identified. In
case of divergence of opinions, the identification of the
theme was based on consensus among the members of
the research team. See Figure 1.
RESEARCH AREAS QUESTIONS
Health care How was the health care? Where did you go for help? What was the most relevant aspect of the
health care you received?
How was the rehabilitation during your stay in the hospital? And after discharge from the hospital?
Why and in what aspects?
Role of the health professional In your opinion, what is the role of the involvement and attitude of the health professional in your
rehabilitation process? What aspects make a professional relevant to you?
Professional-patient relationship What relevance does the professional-patient relationship have for you? What is most necessary
on behalf of the professional? and on behalf of the patient? What is most relevant for you in this
relationship?
What role does communication play in the professional-patient relationship? What should it be like
for you? What about professional support? What about your participation in your process?
Barriers and facilitators in the
therapeutic relationship
What barriers and/or facilitators can influence the therapeutic relationship? What about
communication? What about professional support? What about your participation during your
process?
Table 1 Semi-structured interview guide.
4Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
METHODOLOGICAL RIGOR
We used criteria by Guba and Lincoln for establishing
trustworthiness of the data by reviewing issues
concerning data credibility, transferability, dependability,
and confirmability [32]. Table 2 summarizes the
procedures used to enhance trustworthiness.
ETHICS
The current study was approved by the Ethical Committee
of Universidad Rey Juan Carlos (code: 2106201911119)
and the Ethical Committee of Hospital Universitario
Fundación Alcorcón (code: 19/69). Participants provided
oral informed consent prior to their inclusion in the study.
RESULTS
The sample consisted of 31 patients with stroke (11
women) with a mean age of 64 years (SD = 15) with a
NIHSS scale of 64.52% (n = 20), and 35.48% (n = 11),
indicating moderate and severe stroke, respectively. The
characteristics of the participants are shown in Table 3.
RESULTS OF THE THEMATIC ANALYSIS
The themes that explain the professional care experience
of patients with stroke were 1) Providing support, with
four categories, professional behavior, personalized care,
the heart of the professional and building a bond with
Figure 1 Description of the data analysis process.
CRITERIA TECHNIQUES PERFORMED AND APPLICATION PROCEDURES
Credibility Investigator triangulation: each interview was analyzed by two researchers. Thereafter, team meetings were performed
in which the analyses were compared, and themes were identified.
Triangulation of data collection methods: unstructured, semi-structured interviews were conducted, and researcher
field notes were kept.
Member checking: this consisted of asking the participants to confirm the data obtained during the data collection.
Transferability In-depth descriptions of the study were performed, providing details of the characteristics of researchers, participants,
contexts, sampling strategies, and the data collection and analysis procedures.
Dependability Audit by an external researcher: an external researcher assessed the study research protocol, focusing on aspects
concerning the methods applied and study design.
Confirmability Investigator triangulation, data collection and analysis triangulation.
Researcher reflexivity was encouraged via the completion of reflexive reports and by describing the rationale for the study.
Table 2 Trustworthiness techniques.
5Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
the patient; 2) Facilitating communication, with three
categories, the patient as the recipient, the content of the
message and the channel, and the professional as the
conveyer of the message; and 3) Promoting participation,
with two categories, barriers, and incentives to participate.
See Table 4, Identified themes and categories.
Participants’ narratives, extracted directly from
interviews, described each identified theme [26]. A
detailed summary of the categories, and narratives which
justified the themes obtained is shown in Supplementary
File, Table S1. Summary of the themes, categories, and
narratives.
Theme 1: Providing support
This theme describes how the professional can support
the patient, according to their behavior, and provide
personalized care, where the professional builds a bond
with the patient.
Category: Behavior of the professional.
Patients highly valued professionals paying full attention
during their consultation or treatment, without
simultaneously performing other tasks (i.e., checking
their phone, typing on the computer). Furthermore, “the
fact that the patient talks and the professional listens”
was associated with being a good professional and was
seen as a stimulus to share their experiences and provide
information. When the professional asks the patient
questions, this was perceived as a sign of concern on
behalf of the professional: “It seems very important to
me, to be asked how you are doing with your disease. It
shows interest and concern and provides an indication of
the type of professional you are.” (P17). This means that
they are paying attention to the person’s problems and
seeking to understand them. Patients considered that the
fact that the professional displays commitment to solve
their problems, and professional dedication, and has
gestures with patients that make them feel comfortable
and safe, are all aspects that show that they are with a
high-quality professional: “It shows in the shifts. We can
all do a job, but the attitude with which things are done is
relevant. Maybe things don’t work out, but you put all your
love and all your effort into it, so, for me that’s enough.”
(P2)
Category: Personalized care.
For patients, personalized care means knowing and
understanding their needs, their family context, their way
of life and their emotions, and adapting the treatment
as necessary. In addition, the professional must consider
patients’ concerns, the importance of the disease in the
patient’s life, the role of values and beliefs, and assign
value to their emotions and feelings: “I have concerns,
I’m sure they won’t solve all of them, but it is important
to perceive that they are concerned about solving the
most important ones for me.” (P29). Patients described
how the disease can be experienced differently by each
person, which conditions their priorities, demands and
expectations to solve it.
The patients interviewed pointed out that ’t is
necessary for professionals to share time and space with
patients, thus, professionals should not be in a hurry,
they should try to face work overload, avoiding actions
becoming automatic and should endeavor to ensure that
care is not impersonal or an administrative formality.
Patients noted that the extent of the professional’s
interest is determined based on the time dedicated to
the patient.
Category: The heart of the professional.
The patients who participated in this study described
how the way they are treated influences how they
cope with the disease and their acceptance of the
treatment. Thus, when they perceive “affection” from the
professional, described by patients as “that spark” that
makes them feel better, they feel that the professional
is approachable and therefore not cold and distant: “The
spark is giving a lot of love and affection (...) When you put
your affection into something, everything feels better. It’s
something you notice in people, and it makes a difference
NUMBER OF
PARTICIPANTS
N = 31
Sex Female: n = 11 (35.48%)
Male: n = 20 (64.51%)
Age Average: 64 years
SD: 15
Stroke type Hemorrhagic stroke: n = 7 (22.58%)
Ischemic stroke: n = 24 (77.42%)
Time of stroke evolution Average: 38 months
SD: 35
NIHSS scale Moderate: n = 20 (64.52%)
Severe: n = 11 (35.48%)
Barthel index
(functional state)
Mild: n = 11 (35.48%)
Moderate: n = 12 (38.71%)
Severe: n = 8 (25.81%)
Table 3 Profile of participants.
THEMES CATEGORIES
Theme 1.
Providing
support
Professional behavior
Personalized care
The heart of the professional
Building a bond with the patient
Theme 2.
Facilitating
communication
The patient as the recipient
The content of the message and the channel
The professional as the conveyer of the message
Theme 3.
Promoting
participation
Barriers to participation
Incentives to participate
Table 4 Themes and categories.
6Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
among professionals.” (P2) Some patients referred to this
as receiving “caring” treatment and feeling “pampered”.
Another key aspect was “closeness”. Patients described
that “a close professional” is one who supports the
patient, who is a reference figure, and can be counted
on. Patients described feeling “swaddled”. The narratives
describe how physical contact with the professional
provides them a sense of security. Shaking hands, a hug, a
comforting caress, conveys companionship, and reminds
them that they are not alone: “Do you know what it’s
like to have someone give you a hug in this situation? It’s
what you need at that moment, a help you don’t expect,
the gesture that you’re not alone.” (P29) Finally, patients
described that smiling at the patient is perceived as a
sign of closeness and companionship; they felt that the
professional conveys joy.
Category: Building a bond with the patient.
The patients interviewed noted the importance of getting
to know personal aspects of the professional, and for the
professional to also open up to them. This allowed them
to experience a more personal relationship with the
professionals, beyond the provision of treatment or care.
They already knew the professional, and now they know
the person. For patients, this means the professional
is placed on the same level of mutual knowledge as
themselves. Consequently, patients described that the
treatment changes, they have more confidence, they can
ask questions, and express themselves without filters or
fear.
Patients emphasized how “putting themselves in the
other person’s shoes”, “getting into their skin” would help
professionals to understand them better, increase their
trust and improve the professional-patient relationship:
“It seems like an everyday thing that doesn’t require any
effort, however, for me it was a whole new world. It is
necessary for a professional to understand what a stroke
means and the consequences it has, from the patient’s
point of view (...) If they do, when I say I’m tired, they
understand that I’m tired, because they are putting
themselves in my place and know what is happening
to me. That gives me confidence. Respecting others is
much easier, when you put yourself in their place, and
by understanding what happens to patients, everything
is much easier.” (P20) For patients, trust is everything,
however, it is not given freely, it must be earned. Thanks
to trust, the patients put themselves “in the professional’s
hands”. Mistrust appears when the professional loses
credibility. This appears when they feel deceived,
when a treatment is prolonged longer than expected
(entailing costs for the patient), when a professional
fails to recognize their mistakes, or to show interest, and
when they are unfamiliar with the disease and/or its
evolution. Finally, humor is considered as a facilitator of
the relationship with the professional. Sharing moments
of humor and laughter enables the patient to relax and
enhances the feeling of closeness with the professional.
Humor is displayed by making jokes with professionals.
For patients, a feeling of camaraderie and complicity is
generated: “It’s essential. If you laugh with someone then
it’ s different (...) There is a camaraderie. And when you go
to therapy, you make jokes, they encourage you, and the
treatment is experienced differently.” (P6)
Theme 2: Facilitating communication
This topic describes how communication should be from
the patients’ perspective and which elements facilitate
or hinder it.
Category: The patient as the recipient.
Patients appreciated it when the professional adapted
the message and the information they want to transmit,
avoiding technical language. The use of technicality
was perceived as remoteness or coldness on behalf of
the professional: “You can tell when there is no closeness
with the professional, because they only use technical
terms, such as ischemic damage. And when you ask him
what it is, he responds with more words that you don’t
understand.” (P6). When the message was tailored
to the patient, patients felt that they were “talking on
the same level” with the professional, even if it was
not the same vocabulary. Patients reported how, at
times, professionals chooe to convey the information to
another person first, usually a family member. This was
a source of anger and frustration among patients, since
they prefer to be the first ones to receive the information,
regardless of the reasons for informing the family first,
for example, to avoid worrying the patient. According to
the patients interviewed, the information received tends
to be accepted without being questioned, in cases where
there is a previous relationship, or the professional knew
the patient.
Category: The content of the message and the channel.
The patients emphasized that they need to receive
information about their disease, its causes, implications,
and evolution. They require information that will help
them to understand how the disease will impact
their life and that of their family. Any information that
does not meet these criteria is considered useless.
Moreover, patients reported that some professionals
include words of encouragement and support in the
technical information contained in their message. This is
experienced as a “morale booster” and is seen as a sign
of the professional’s concern and involvement: “When
it comes to stroke, the professional must be positive, to
help you, to encourage you. Saying a positive word to you
doesn’t hurt. By encouraging me, he showed me that he
understood perfectly well what I had, and I was trying
hard to get better.” (P17) Patients also pointed out the
need to establish official communication channels, as
well as the use of alternative communication channels
7Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
such as telephone and e-mail. However, alternative
channels are avoided because they lose the proximity
with the professional.
Category: The professional as the conveyer of the
message.
Patients recounted that health professionals should
be trained to convey information and develop skills
to improve their communication with patients. The
technical knowledge of the profession is different from
the communication skills they must develop. This
training should be mandatory for all professionals.
Communicating while avoiding bluntness with patients is
perceived positively and is highly desirable: “It’s not just
about explaining things, you must know how to explain
it. When you have a certain responsibility, you must know
how to communicate. You have to give feedback in a
non-aggressive way, even if it is negative feedback. You
have to know how to give negative news without crushing
anyone.”(P29). In addition, receiving certain information
or the way it is conveyed is seen as an obstacle to
recovery. Patients described that some professionals
only focus on “what has been lost”, on the limitations
that remain, on the sequelae, on what is not going to
be recovered. In addition, they focus all their information
on informing the patient of the limited possibility of
rehabilitation, on what they will not be able to do. This is
experienced as “dynamiting” the patient’s recovery and
they feel “marked” by the professional’s words.
Theme 3: Promoting participation
This theme describes barriers and facilitators for patient
participation.
Category: Barriers to participation.
Some patients reported that they preferred not to give
their opinion or participate in their process or in the
planning of activities, since they lack knowledge. They
tended to listen to what the professional said. Other
patients felt that they were unable to give their opinion
or act, as they were not involved in the decisions. They
saw themselves as “the last link” in the chain. Treatment
objectives are set without the patient’s input and
participation. The patient must accept the objectives
and treatments that are prescribed and wait to see if
they work. “To accept or to wait”, is seen by patients as
a way of not involving them in their process. Patients
narrated that some professionals try to act as if they
know what it is like to live with the disease, more so than
the patient who is suffering from it. Patients described
feeling a barrier when the professional acts pretentious.
The professional knows everything by virtue of being
a professional: “The roles are very different. There is an
invisible barrier that you notice right away; those who are
in charge and those who are not in charge, those who
know and those who don’t know.” (P10). Consequently,
patients perceived a lack of control, as they cannot
decide, they lose control and feel like they are in
someone else’s hands.
Category: Incentives to participate.
The professional actions that facilitate patient
participation include asking about their process, providing
information on therapeutic decisions and changes,
continuous updating on the evolution of their disease
and allowing each patient to participate in their recovery
according to their possibilities. In addition, patients
reported that being consulted about their preferences
encourages them to participate in the shared decision-
making process: “There are two different approaches
used by health care providers. On the one hand, those
who don’t allow you to participate and tell you what to
do, and on the other, those who consult you. I prefer
the people who try to get you more involved. It means
that they ask me what I expect, how I want to do it.
Considering me as a person who can contribute things.
It means talking together to see how we can do it.” (P9)
For them, the recovery process is a joint process between
the patient and the professionals. Sometimes, patients
even described that they needed to feel the involvement
and desire of the professionals to get them back on the
“playing field” and participating again. Furthermore,
the fact that the professional corrects the patient’s
mistakes or errors and redirects them during treatment
is well received and does not prevent the patient’s
participation in decisions. This is appreciated as a sign of
the professional’s involvement.
A summary of the facilitators (enablers) and barriers of
professional support, communication and participation
with stroke patients is shown in Supplementary File,
Table S2.
DISCUSSION
Our results revealed the elements that professionals can
use to support and build bonds with patients, improve
communication, and facilitate participation from the
perspective of stroke patients. Patient experience is
more than “patient satisfaction,” and asking patients
“what happened” during an episode of care is more
valid for judging the quality of care than simply asking
about “satisfaction” [3, 33]. The National Institute for
Health and Care Excellence [34], developed a quality
standard that provided healthcare professionals with
clear guidance on the components of a good patient
experience, summarized in six quality statements
against which patient experience can be measured.
These statements include empathy, dignity, and respect;
contacts for ongoing care; information exchange;
individualized care; preferences for sharing information;
and decision making.
8Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
Regarding the aspects that influence the patient’s
perspective on the support and professional help
received, previous studies described how patients
have expectations of building a relationship based on
caring, and where they expect professional behaviors
and attitudes to match or respect their needs [35].
Pallesen et al. [36] and Batbaatar et al. [4] showed how
patients consider and perceive the support perceived
by professionals as a cornerstone that influences their
recovery process. Professional support influences
the satisfaction perceived by stroke patients and
their families and should be based on the individual
characteristics of each patient and family [37]. The
professionals’ consideration of the expectations of
the stroke patient and their family, considering their
particularities, together with the professional’s efforts to
improve the quality of interpersonal care and treatment
of the patient, facilitate the patient-professional
relationship [36]. Considering the patient’s individuality,
personalized care means knowing the patient’s needs,
concerns, expectations and emotions. This forces the
professional to adopt different roles in the relationship
with the patient. Parker et al. [11] showed how patients
expect physicians to act as a drug (the relationship
with the physician is therapeutic for the patient), as a
detective and validator (identification and categorization
of symptoms), and as a collaborator (patients prefer a
collaborative partnership). Also, according to Parker et
al. [11] patients are immersed in mental and emotional
concerns (stress, anxiety, fear, uncertainty) that can
affect their recovery. Professional support, through
close accompaniment (based on the patients’ needs
and context), helps stroke patients to understand and
validate their concerns, and helps to build a trusting
relationship based on empathy, care and understanding
[38]. This improves the bond and the relationship
between the professional and the patient and improves
the patients’ sense of security by reducing post-stroke
stress and anxiety [39]. Previous studies [24, 40] reported
how patient-centered care is an element of support for
the person who has suffered a stroke, and of relevance
in clinical management, which should be considered as
another element in the recovery and treatment planning
process.
Communication is essential in the experience of
stroke patients and is the key tool for the professional
to provide clear and accessible information to patients
[33]. To facilitate and improve communication, the
professional must consider the patient as the receiver
of the information, adapting the message, speaking at
the same level, and trying to avoid the use of highly
technical language [34]. Previous studies describe
how employing strategies to promote communication
and understanding avoids disappointment and
unrealistic goals in stroke patients [41]. In addition, the
professional must know how to convey the information,
providing information about the disease, and conveying
words of encouragement in the message [41]. In the
systematic review by Burton et al. [42] regarding the
experiences of patients with acquired neurological
conditions and their caregivers about the process of
receiving information about recovery, the importance
of providing the right information at the right time is
described, together with managing expectations and
the way in which the message is given, learning to talk
about recovery, and managing emotions in an uncertain
context such as the recovery of acquired neurological
processes. Communication between the stroke patient
and healthcare professionals helps to adjust patients’
expectations towards recovery during rehabilitation
[43]. In addition, professionals should avoid highlighting
the limitations of patients who have suffered a stroke
[44]. This inadequacy of the information provided
by professionals generates anxiety and fear and
discourages participation in recovery [44].
In relation to communication, patient participation
is based on shared understanding and comprehension
between patients and professionals in order to make
decisions about the short and long term recovery process
of stroke patients [24]. Our results reveal how patients
encounter barriers to participation, considering that
their process is in the hands of others. Previous studies
described how stroke patients admitted to specialized
rehabilitation centers did not participate in any aspect of
post-acute care [45]. Some of the reasons for this include
lack of knowledge or lack of skills to re-engage [46].
Lindblom et al. [25] described how patient involvement
should be based on professional-patient interaction
and clear assignment of roles. Previous studies [47]
highlight different professional factors that facilitate the
participation of stroke patients, such as consulting them
about their expectations, showing involvement in the
patient’s recovery, and jointly establishing therapeutic
objectives and goals [25]. Moreover, Parsons et al. [48]
in their research on stroke rehabilitation clinician’s
perceptions of the patient as an active partner in
setting goals within stroke rehabilitation and factors
that influence patient engagement, identified barriers
to the participation of patients and their families such
as knowledge of the patient and family, the role of
the patient in setting goals, the effect of clinician’s
attributes on goal setting, goal-setting at the home
versus hospital, and professional/funder expectations of
clinicians.
The present study has several limitations. First, one
of the researchers had contact with the participants.
However, data collection and analysis were controlled
by other members of the research team. Secondly,
participants were asked about “health professionals”
without specifically focusing on any type of professional.
This was done to give participants more freedom to
respond and to avoid directing or limiting their response.
9Martin-Sanz et al. International Journal of Integrated Care DOI: 10.5334/ijic.6526
CONCLUSIONS
Based on the perspective of our participants, our results
show relevant points that professionals should consider
when providing support, communicating information,
and encouraging the participation of stroke patients.
In addition, barriers and facilitators are identified for
providing support to patients, for communication and
transmission of information, and for encouraging the
participation of stroke patients in their recovery.
Considering the stroke patient’s perspective on how the
professional should support, communicate, and provide
information, and encouraging patient participation has
great clinical relevance for health professionals, as it can
enhance the professional-patient relationship and impact
decision making, treatment regimens, and adherence to
health care recommendations and interventions. This
improves the holistic understanding of the stroke patient
in integrated care, increasing the quality of care and its
results.
ADDITIONAL FILE
The additional file for this article can be found as follows:
• Supplementary files. Table S1 and Table S2. DOI:
https://doi.org/10.5334/ijic.6526.s1
ACKNOWLEDGEMENTS
We would like to thank the selfless contribution and
involvement of the study participants, as well as the
support of San Vicente Neurological Rehabilitation Clinic
and the Rehabictus Rehabilitation Center
REVIEWERS
Three anonymous reviewers.
FUNDING INFORMATION
This research was funded by a grant from la Sociedad
Española de Calidad Asistencial (SECA) and la Fundación
Española de Calidad Asistencial (FECA) [the Spanish
Society for the Quality of Care (SECA) and the Spanish
Foundation for the Quality of Care (FECA)] (2019/2020
RESEARCH GRANTS). The SECA-FECA has not been
specifically involved in the research. The authors
report no involvement in the research by the sponsor
that could have influenced the outcome of this
work.
COMPETING INTERESTS
The authors have no competing interests to declare.
AUTHOR AFFILIATIONS
Belen Martin-Sanz orcid.org/0000-0001-8628-0979
Research Group of Humanities and Qualitative Research in
Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), ES
Rosa María Salazar-de-la-Guerra orcid.org/0000-0002-2915-907X
Servicio Madrileño de Salud (SERMAS), ES
Juan Nicolas Cuenca-Zaldivar orcid.org/0000-0002-6787-3944
Servicio Madrileño de Salud (SERMAS), ES
Ana María Aguila-Maturana orcid.org/0000-0001-5996-2632
Hospital Universitario Fundación Alcorcón, ES
Cristina Garcia-Bravo orcid.org/0000-0002-6437-6758
Research Group of Humanities and Qualitative Research in
Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), ES
María Salcedo-Perez-Juana orcid.org/0000-0001-7580-9670
Research Group of Humanities and Qualitative Research in
Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), ES
Ester Capio-Calatayud
Department of Physical Therapy. Centro de Hospitalización y
Rehabilitación, ES
Domingo Palacios-Ceña orcid.org/0000-0003-0669-6339
Research Group of Humanities and Qualitative Research in
Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), ES
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TO CITE THIS ARTICLE:
Martin-Sanz B, Salazar-de-la-Guerra RM, Cuenca-Zaldivar JN, Aguila-Maturana AM, Garcia-Bravo C, Salcedo-Perez-Juana M, Capio-
Calatayud E, Palacios-Ceña D. Understanding the Professional Care Experience of Patients with Stroke: A Qualitative Study Using In-
Depth Interviews. International Journal of Integrated Care, 2022; 22(4): 2, 1–11. DOI: https://doi.org/10.5334/ijic.6526
Submitted: 14 February 2022 Accepted: 14 September 2022 Published: 07 October 2022
COPYRIGHT:
© 2022 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0
International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
International Journal of Integrated Care is a peer-reviewed open access journal published by Ubiquity Press.
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