Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study.
Amanda Gahlot, Grace Richardson, Patricia Librea and 1 others
PMID 39363988WHAT IT FOUND
Experienced therapists found shared decision-making harder than traditional instruction, often reverting to telling patients what to do.
Patients valued the autonomy but some struggled without prior education. Success relied on building trust, though clinicians feared the time cost and billing challenges.
Key findings
01Clinicians described shared decision-making as uncomfortable, demanding, and abstract, with some reverting to a traditional instructive model.
02Patients reported increased empowerment and control, but some lacked confidence in their own expertise and preferred the traditional model where the clinician is the expert.
03Patients felt shared decision-making was inappropriate earlier in recovery due to a lack of foundational knowledge, suggesting it suits the chronic phase better.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The sample size was small, and data saturation was not confirmed. All three clinicians were highly experienced and in supervisory roles, so less experienced therapists may have different barriers. All participants were comfortable with virtual technology, excluding those affected by the digital divide. No member checks were performed to validate interpretations with participants. The study did not measure clinical outcomes like arm function, only experiences and perceptions.
Declared interests
The authors declare financial support from the American Occupational Therapy Foundation Interventional Research Grant.
The easy way to misread this
Do not interpret these findings as evidence that shared decision-making improves arm function or adherence. This study reports only the subjective experiences of participants and clinicians regarding the implementation process, not the clinical effectiveness of the intervention.