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A New Process Model for Relationship-Centred Shared Decision-Making in Physical Medicine and Rehabilitation Settings.
Papadimitriou, Christina; Clayman, Marla L; Mallinson, Trudy; Weaver, Jennifer A; Guernon, Ann; Meehan, Albert J; Kot, Trisha; Ford, Paige; Ideishi, Roger; Prather, Christina; van der Wees, Philip.
Afiliación
  • Papadimitriou C; School of Health Sciences, Oakland University, Rochester, Michigan, USA.
  • Clayman ML; Department of Population and Quantitative Health Sciences, Edith Nourse Rogers Memorial Veterans Hospital, UMass Chan Medical School, Bedford, Massachusetts, USA.
  • Mallinson T; Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA.
  • Weaver JA; Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA.
  • Guernon A; Department of Speech-Language Pathology, Lewis University, Romeoville, Illinois, USA.
  • Meehan AJ; Department of Sociology, Anthropology, Criminal Justice, and Social Work, College of Arts & Sciences, Oakland University, Rochester, Michigan, USA.
  • Kot T; Care Partner Collaborator.
  • Ford P; Care Partner Collaborator.
  • Ideishi R; Department of Occupational Therapy, George Washington University, Washington, DC, USA.
  • Prather C; Division of Geriatrics and Palliative Medicine, George Washington University, Washington, DC, USA.
  • van der Wees P; Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA.
Health Expect ; 27(4): e14162, 2024 08.
Article en En | MEDLINE | ID: mdl-39140244
ABSTRACT

INTRODUCTION:

We 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.

METHODS:

To 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.

FINDINGS:

Our 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).

DISCUSSION:

Relationships 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 CONTRIBUTION Care 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Participación del Paciente / Medicina Física y Rehabilitación / Toma de Decisiones Conjunta Límite: Humans Idioma: En Revista: Health Expect Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Participación del Paciente / Medicina Física y Rehabilitación / Toma de Decisiones Conjunta Límite: Humans Idioma: En Revista: Health Expect Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido