The tensions between risk and choice: Perspectives of Australian occupational therapists about informed choice when working with older people.
Sathya Viswanathan, Sarah McMullen-Roach, Scott Weeks and 1 others
Ten Australian OTs describe a persistent tension between supporting an older person's choice and managing risk.
They navigate it through negotiation, tailored communication, and team work with family — but report that organisational policies and duty-of-care obligations sometimes override the client's preference.
Key findings
1OTs described a recurring tension between respecting client choice and their professional obligation to manage risk. Their typical response was not to refuse or simply comply, but to negotiate, be honest about their concerns, offer safer alternatives, and monitor the situation over time.
2Communication was the central skill for enacting informed choice. OTs described building rapport before presenting options, tailoring information to the client's literacy, culture, and cognitive capacity, using demonstrations and written materials, and giving clients time to process before deciding.
3OTs reported that organisational policies, the Aged Care Quality Standards, and documentation requirements (including a 'dignity of risk form') shaped what choices they could offer and how they had to record risk conversations. Some described these as protective; others noted they could constrain client choice or create ambiguity in edge cases.
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What it does not show
Ten participants, eight of whom were from South Australia and most worked in metropolitan areas, so the perspectives may not represent rural or other-state practice. All participants were occupational therapists; the paper does not capture the older person's or family's experience of the choice process. Seven of ten interviews were conducted via Zoom, which the authors note may have limited observation of non-verbal cues. Participants were not explicitly asked to differentiate their approach for clients with and without cognitive impairment, so the findings blend these populations. The first author was an OT honours student working part-time in aged care; while she was unknown to participants, her positionality as a trainee may have shaped the questions asked and the depth of responses. This is a self-report study: participants describe what they do, not what actually happens in the room or whether the client's choice was genuinely enacted.
Declared interests
No funding source is stated in the text. Dr Carolyn Murray, a co-author, is an Associate Editor for the Australian Occupational Therapy Journal (the journal in which this paper is published); she was removed from all peer review and editorial processes for this manuscript. The first author was an OT honours student at the University of South Australia, which granted ethics approval.
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