A Thematic Analysis of Encounters Between Those with Sickle Cell Disease and Their Healthcare Professionals Where Medication Is Discussed

Sickle-cell disease (SCD) is a serious genetic blood disorder. At the time this study was conducted, only one drug treatment for SCD, hydroxycarbamide, was available. Research suggests that hydroxycarbamide is underutilised in the UK, and that adherence is low in those who take the medicine. The aim of the current study was to examine decision making and adherence from a relational perspective, specifically to answer the question: how do those with SCD who have been recommended to take hydroxycarbamide experience their medical encounters where the medicine has been initially recommended and where hydroxycarbamide is monitored over time? Eight participants with SCD who had engaged in conversations with healthcare providers where hydroxycarbamide was recommended were recruited to take part in the current study. Semi-structured interviews were used to explore their experiences and data were analysed using reflexive thematic analysis with attachment theory as the theoretical framework. Four themes containing nine subthemes were identified. The themes were: perceptions of vulnerability underpin the relationship; past relationships and templates impacting on the present; maintaining independence; and the adequacy of the response. The results of this research suggest that relational dynamics between healthcare provider and patient are present and actively involved in the processes of initial decision making and subsequent adherence to hydroxycarbamide in those with SCD. Theoretical and clinical implications are discussed, along with some suggestions for future research. One important implication of the current study is that counselling psychologists working with those with SCD in healthcare settings will need to hold in mind multiple perspectives including evidence derived from the medical model, the patient’s own understanding of their illness as well as cultural and historical considerations. The clear contribution that counselling psychology can make to support healthcare practitioners to work relationally with those with SCD is also described.