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

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Patients and staff generally agree on shared decision-making in rehabilitation goal-setting meetings. However, patients desire clearer communication and feel staff may not always listen, impacting their participation.

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Area of Science:

  • Gerontology
  • Rehabilitation Medicine
  • Health Psychology

Background:

  • Shared decision-making (SDM) is crucial for patient-centered goal setting in rehabilitation.
  • Understanding patient perspectives on SDM is vital for improving engagement and outcomes in frail elderly individuals.

Purpose of the Study:

  • To evaluate the extent of SDM during rehabilitation goal-setting meetings.
  • To identify patient-reported factors influencing their participation in SDM.

Main Methods:

  • A mixed-methods study combining questionnaires (MAPPIN'SDM) and semi-structured interviews.
  • Data collected from rehabilitation team members and frail elderly patients (mean age 83).
  • Observer, patient, and staff ratings of SDM competencies were compared.

Main Results:

  • Staff demonstrated good SDM competencies, particularly in using understandable language.
  • Patients reported a lack of discussion on rehabilitation pros and cons and perceived differences in problem discussion compared to staff.
  • Patient interviews revealed motivation, self-confidence, family support, and clear communication from staff as key facilitators for participation.

Conclusions:

  • While staff generally exhibit good SDM skills, patients experience gaps in information sharing and feel unheard.
  • Addressing communication clarity and active listening is essential to enhance patient involvement in goal setting.
  • Further research and practical interventions are needed to improve SDM in geriatric rehabilitation.