Critical moments in doctor-patient conversations in the context of complex conditions using the example of endometriosis : what coaching research and practice can contribute to the development of relational capabilities

Doctor–patient conversations in healthcare are foundational. They can be challenging, especially when decisions involving complexity are involved. When a patient faces a life restricting diagnosis, conversations with the doctor become critical in understanding diagnosis, treatment and likely outcomes. Hence, relating during crucial moments of such consultations deserves particular attention, to better understand ways in which the intimate nature of issues, and the far-reaching implications for patients, can be considered. The combination of often turbulent illness trajectories (diagnosis delay and potential associated damage caused), combined with the frequently existential nature of issues raised (having children, sexual wellbeing), is prone to trigger memories of challenging situations. Consequently, it is a common interest of both doctors and patients to ensure that the preparation for and the making of decisions are conducted in the best possible way. The purpose of this study is to explore how doctors and patients relate in critical moments of consultations, when considering complex conditions, such as life-restricting forms of endometriosis. The aim is to gain a more nuanced understanding of what quality decision-making in this context means, while ensuring that the research is grounded in the challenges that participants encounter in real life. The study involves the analysis of conversations between doctors and their patients at different stages of care. Patients in these situations are challenged to deal with uncertainty relating to what it means to live with the unpredictability of the condition, how it develops and how treatment takes effect; accordingly, they often experience unexpected strong emotions. Doctors, in addition to applying clinical reasoning, need to hold a safe relational space for patients to express their feelings. Simultaneously, they are called to work with and use their own emotions to guide the conversation in the best interest of the patient. Researching both doctor and patient perceptions of critical moments of encounters and their reflection on these moments can provide a better understanding of how doctors guide inquiry, and how they notice and respond to what is important for the patient during the decision-making conversation and beyond. It is of particular interest to better understand which relational capabilities and practices foster collaboration in this context, as qualitative capabilities and associated practices can be crucial in creating a shared understanding of events, in preparation of decision-making in states of uncertainty. This study is based on case studies in tertiary and primary care, using an exploratory qualitative design. Data collection included the recording of consultations and separate interviews with doctors and patients about experienced critical moments and their effect. Findings indicate that the more doctors are aware of their contributions to patient decision-making, the more they consider the importance of dealing with complexity and holding space for strong emotions. This, in turn, suggests that reflective practice on condition-specific issues, identified in this study, can support doctors in developing relational capabilities aimed at guiding decision-making in ways that are relevant to individuals on their illness journeys with endometriosis. In parallel, critical moments during decision-making can be grounds for patients to learn more about how to improve their quality of life, and to view their illness trajectories with a more hopeful outlook.