How can healthcare professionals work with families to address misaligned expectations of recovery in brain injury rehabilitation? A scoping review

Introduction: Most survivors of severe acquired brain injuries will have significant long-term disability. During inpatient rehabilitation, families often have expectations of recovery that do not match healthcare professional opinion. This impacts on patient care, service processes, professional-family relations, and wellbeing. This review aimed to understand how family expectations are managed in this setting, and to explore potential areas of improvement.

Method: A scoping review was conducted by searching CINAHL, Medline, EMBASE and Web of Science. Krieger et al’s ‘Conceptual Building Blocks’ provided a framework to analyze the data using a ‘best fit’ framework synthesis approach.

Results: Twenty-one papers were included in the review. Six sub-themes within three overarching themes were generated, which explored recommendations for effective expectation management. The sub-themes within the ‘staff behaviors’ theme were ‘appropriate information provision,’ ‘open communication’ and ‘prioritize family.’ Sub-themes within ‘system behaviors’ were ‘cultural change’ and ‘increased resource.’ ‘Rehabilitation as a shared process’ was the third theme.

Discussion: Misaligned expectations of recovery appear to reflect a range of unmet family needs related to their position within the healthcare hierarchy, professional-family communication, and their involvement in rehabilitation processes. Early identification of family and healthcare professional expectations alongside regular review may prevent misunderstanding and conflict.