A New Process Model for Relationship‐Centred Shared Decision‐Making in Physical Medicine and Rehabilitation Settings

Author:

Papadimitriou Christina1ORCID,Clayman Marla L.2ORCID,Mallinson Trudy3ORCID,Weaver Jennifer A.4ORCID,Guernon Ann5ORCID,Meehan Albert J.6ORCID,Kot Trisha7,Ford Paige7,Ideishi Roger8ORCID,Prather Christina9ORCID,van der Wees Philip3ORCID

Affiliation:

1. School of Health Sciences Oakland University Rochester Michigan USA

2. Department of Population and Quantitative Health Sciences Edith Nourse Rogers Memorial Veterans Hospital, UMass Chan Medical School Bedford Massachusetts USA

3. Department of Clinical Research and Leadership George Washington University Washington DC USA

4. Department of Occupational Therapy Colorado State University Fort Collins Colorado USA

5. Department of Speech‐Language Pathology Lewis University Romeoville Illinois USA

6. Department of Sociology, Anthropology, Criminal Justice, and Social Work, College of Arts & Sciences Oakland University Rochester Michigan USA

7. Care Partner Collaborator

8. Department of Occupational Therapy George Washington University Washington DC USA

9. Division of Geriatrics and Palliative Medicine George Washington University Washington DC USA

Abstract

ABSTRACTIntroductionWe present a relationship‐centred shared‐decision‐making (RCSDM) process model to explicate factors that shape decision‐making processes during physical medicine and rehabilitation (PMR) encounters among patients, their care partners and practitioners. Existing shared decision‐making (SDM) models fall short in addressing the everyday decisions routinely made regarding persons with chronic disabilities who require high levels of support, their care partners and rehabilitation practitioners. In PMR, these everyday decisions are small scale, immediate and in service to a larger therapeutic goal. They can be thought of as micro‐decisions and involve multiple practitioners, care partners and patients. How micro‐decisions are made in this context is contingent on multiple roles and relationships among these relevant parties. Our model centres on micro‐decisions among patients, their care partners and practitioners based on our disorders of consciousness (DoC) research.MethodsTo develop our model, we examined peer‐reviewed literature in SDM in PMR, chronic disability and person‐centeredness; formed collaborations and co‐created our constructs with rehabilitation practitioners and with care partners who have lived experience of caring for persons with DoC; analysed emerging empirical data and vetted early versions with expert scientific and clinical audiences. Our model builds from the core tenets of relational autonomy, and scholarship and activism of disability advocates.FindingsOur model conceptualizes four non‐hierarchical levels of analysis to understand the process of micro‐decision‐making in chronic disability and medical rehabilitation: social forces (historical and sociological); roles and relationships (multiple and intersecting); relational dimensions (interactional and contextual) and micro‐decision moments (initiation, response and closure).DiscussionRelationships among patients, their care partners and practitioners are the intersubjective milieu within which decisions are made. Our conceptual model explicates the process of micro‐decision‐making in PMR.Patient or Public ContributionCare partners (or caregivers) and rehabilitation practitioners are active members of our team. We work together to develop research projects, collect, analyse and disseminate data. The conceptual model we present in this manuscript was co‐created—input from care partners and practitioners on previously collected data became the impetus to develop the RCSDM process model and share co‐authorship in this manuscript.

Publisher

Wiley

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