How to get one's voice heard:: the problems of the discharge planning conference

Aims. This paper reports a study describing how patients, relatives and healthcare professionals dealt with the variety of problems and responsibilities that occur in discharge planning conferences and especially how they managed to do this given the institutional frame that surrounded the meeting. Background. In Sweden, the aim of a discharge planning conference is to co-ordinate social and healthcare resources as patients are discharged from hospitals. Patients, relatives and hospital staff, along with healthcare professionals responsible for outpatient care, assemble to achieve an individual care plan. One of the explicit principles informing the discharge planning conference is to increase patients' influence on decision-making. However, research points at shortcomings in this respect. Method. A discourse analysis was conducted using transcriptions of eight video-recorded discharge planning conferences. The selected patients were eight older women expected to be discharged from hospital. Other participants were staff nurses, social workers and occasionally relatives, an occupational therapist, district nurse or home care aide. Findings. Participants adopted different roles as persons/patients, relative/next of kin and healthcare professionals/institutional representatives during the discharge planning conference, which they simultaneously struggled to act upon. The findings are presented under the categories 'Clashing roles and perspectives' and 'Facing the institutional frame'. Conclusions. The performance of the discharge planning conference in its present form interferes with a caring perspective that protects patients' integrity and gives prominence to their life worlds. Moreover, it does not satisfy patients' and relatives' right to expect proceedings that enhance their possibility to express their personal wishes in a dignified manner.