Shared decision-making within goal-setting in rehabilitation: a mixed methods study

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Colleges, School and Institutes

Abstract

Objectives
To assess the extent of shared decision-making within goal-setting meetings and explore patient-reported factors that influenced their participation to shared decision- making about their goals.
Design
A two-phase, explanatory sequential mixed-methods study, using questionnaires and interviews.
Setting
A rehabilitation centre and patients’ homes.
Subjects
Frail elderly patients
Main Measures
Quantitative data was collected after every patient’s goal-setting meeting using the Multifocal Approach to Sharing in Shared Decision Making (MAPPINS’SDM) questionnaire that assesses competencies relevant to shared decision-making. Shared decision-making was rated by an observer, patients and staff, and compared.
Qualitative data were collected through semi-structured interviews.
Results
Twenty-four rehabilitation team members and 40 patients (mean age 83 years) participated. All study participants felt competency 7a (the language used by staff made sense to the patient), was observed in all meetings. Patients reported that for 22 of the meetings competency 4a, the advantages and disadvantages of rehabilitation, were not discussed. Games-Howell tests for direction of differences between groups showed significant difference (p=0.001) between patients and staff in whether patients’ problems were discussed.
Nine patients’ interviews suggested that motivation, self-confidence, family-support,
preparing themselves, getting information about goal-setting and rehabilitation options could enable them to participate in shared decision-making. They suggested staff should communicate clearly and demonstrate they are listening to patients but
without paternalistic approach.
Conclusions
Staff exhibited most shared decision-making competencies at a good level. However, patients highlighted problems with information-sharing and felt staff might
not be listening to them. Research and practice should explore tools to address these shortfalls.

Details

Original languageEnglish
JournalClinical Rehabilitation
Publication statusPublished - 4 Dec 2018