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Patients act like hostages in their fear of speaking up: study

Patients who feel unable to assert themselves in the presence of clinicians mirror the behaviour of adult kidnapped hostages, a research team has suggested.

Researchers from Monash Business School and Texas A&M University said the phenomenon, called hostage bargaining syndrome, appears to be the result of an imbalance of power between the patients – particularly those with a serious disease or in a state of great vulnerability – and staff.

Professor Tracey Danaher from the Department of Marketing at Monash Business School said the team made the connection between patients and hostages after noting a reluctance to challenge authority among hostages while looking through sociology research.

“We thought, this is similar to patients who are often very reluctant to assert their interests in the presence of doctors, who they see as experts," Danaher said. “It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one’s better judgment.”

For example, patients and their family members might pick up on subtle behaviours, like a nurse or doctor rolling their eyes or tutting when asked a question and, as a result, feel less inclined to repeat the question in the future or ask a further one.

One study participant described overhearing a nurse label her as 'difficult' when she refused an attempted blood sample draw due to pain. Danaher said: “In that situation, the patient has made an attempt to assert themselves and now because they’ve overheard someone reacting in a negative way … they will feel really reluctant or anxious and stressed to speak up again."

Danaher emphasised that the research team's goal is not to say that clinicians are doing something wrong. “They’re doing an amazing job. Given the pressures of the system that they work in and how time-pressured they are, it is a difficult situation to give every question and every patient time but the reality is that people are already feeling reluctant to speak up,” she explained. “If non-verbal cues show that the care team is disparaging of speaking up or a verbal cue where you’re labelled a difficult patient is given then it really feeds into making people feel more like they’re a hostage to the system.”

To address the issue, Danaher suggested nurses and doctors invite patients to ask questions and raise concerns. "They may need to do this many times before trust is built in the relationship and a patient will speak up.

"Body language and physical positioning — sitting not standing, choosing a place on the same side of a patient’s hospital bed as the family, making physical contact with the patient when appropriate, and minimising distraction and interruption — signal that the clinician values the patient’s perspective.

"Clinicians need to show genuine empathy and incorporate patient and family input into decision making and treatment, when appropriate, to foster a sense of partnership and weaken hostage bargaining syndrome."

Nursing Review spoke with Danaher to find out more about hostage bargaining syndrome and how its impact can be lessened.

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