'Keeping the Peace': Multiple Perspectives on Decision-making Following Acute Stroke in China: A Constructivist Grounded Theory Study

Stroke is a major public health concern in China and worldwide due to its significant mortality and long-term morbidity. Following an acute stroke both older people and their family carers often have to make major life decisions in a relatively short period of time. This study explores the nature of the decisionmaking process between people with stroke, their family carers and professionals in an acute care context in China. Using a constructivist grounded theory approach data were collected through a combination of methods including semi-structured interviews, participant observation, and documentary analysis. This comprised interview data from 19 people with stroke, 28 family carers and 25 professionals together with 55 periods of observation to ensure 24 hour coverage and an analysis of key policy and practice documents. Constant comparative analysis of the data led to the emergence of two core categories, and their associated social processes, these were ‘Keeping the Peace’ and ‘Making Decisions’. The core category ‘Keeping the Peace’ was the most important goal for all three groups of people. This involved both keeping peace of mind for the person with the stroke and keeping peace in relationships between different parties (i.e. interprofessional relationships, inter-familial relationships, patient-carer-professional relationships, and relationships between patient/carer from different families). The core category of ‘Making decisions’ comprised three major social processes of hiding (permanent hiding, temporary hiding, and tailoring to hide), seeking (searching, watching/comparing, and checking) and sharing (informing, advising, exchanging, and tailoring to explain). There was a close and dynamic relationship between ‘Making Decisions and ‘Keeping the Peace’ and both were heavily influenced by Chinese culture, especially the traditional Chinese ideal of maintaining harmony. In addition a broad range of other factors also played a part in the overall decision-making process, including: the people who were involved; the types of decisions to be were made; the types of knowledge that was used; environmental factors; medical/treatment related factors; patient-, carer- and professional-related factors. The grounded theory emerging from this study enhances our understanding of decision-making experiences among older patients with stroke, family carers and