Recommending 24-hour attendant care: A qualitative study exploring the clinical decision-making process of occupational therapists in Ontario, Canada.
Bao-Zhu Stephanie Long, Kishana Balakrishnar, Maryna Mazur and 4 others
PMID 40289528WHAT IT FOUND
Experienced Ontario occupational therapists described deciding on continuous attendant care by blending client interviews, caregiver reports, file review, functional observation, and standardized tests, then relying on clinical judgment and safety risk rather than formal guidelines.
Key findings
01In interviews with nine experienced Ontario occupational therapists, participants described gathering evidence from client interviews, family or caregiver input, functional observations, standardized testing, and file review rather than relying on diagnosis alone.
02Professional judgment, experience, and ethical comfort shaped recommendations, especially when legal or referral pressures were present.
03Safety and imminent risk were prioritized, but therapists did not use a formal tool to assess overall current or future risk.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
All participants were experienced Ontario-based private-practice occupational therapists, so findings may not reflect therapists elsewhere, less experienced clinicians, or public-sector practice. The study explored reasoning, not patient outcomes or the accuracy of care recommendations. The methods describe both no transcript return and participant transcript review, so verification is unclear. Participants were recruited through a professional network and selected for courtroom or complex-case experience, which may concentrate the themes in litigation-heavy practice. It is qualitative, so it cannot establish how often these approaches occur or whether they improve decisions.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the themes as evidence that continuous attendant care is needed or that any assessment method is effective. The study describes experienced Ontario OTs' reasoning; it did not test patient outcomes or compare methods.