Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: towards a theory of authentic caring in clinical relationships.

OBJECTIVE: We developed a method whereby relationships can be studied simultaneously from the perspectives of each party and researchers' observations of their dialogue. Then we used this method to study how to recognise authentic, caring clinical relationships.
METHODS: Participants were 20 patients who had recently received surgery for breast cancer and nine surgeons with whom they had a post-operative consultation. We audiorecorded consultations, before interviewing patients and surgeons about their perceptions of the consultation and each other. Cross-case qualitative analyses (analysing consultations and surgeon and patient interviews, respectively) were supplemented by integrative, within-case analysis.
RESULTS: Surgeons and patients described their relationship as personal and emotional, but emotional talk was absent from consultations. For patients and surgeons, their relationship depended, instead, on surgeons' expertise and character.
CONCLUSION: Our integrative approach suggested that authentic caring in these relationships lay in practitioners' conscientious execution of their role and, contrary to currently influential views, not in an explicit emotional engagement. PRACTICE IMPLICATIONS: Relationships between patients and practitioners cannot be described adequately using analyses of interactions between them. Researchers will need to triangulate between these observations and the patient and practitioner perspectives in order to understand what makes for authentically caring relationships.