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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Key factors in shared decision making between people with osteoarthritis and physiotherapists: A narrative study
J Jager1, I Rosbergen2, G van der Sluis3
1Research group Self-Management in Physiotherapy & Exercise Care, Faculty of Health, University of Applied Sciences Leiden, Leiden, the Netherlands; Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Objectives:
To improve the quality of shared decision-making (SDM), this study examined factors perceived by people with osteoarthritis (PwOA) and physiotherapists to influence shared decision making (SDM), and how these perceptions align with a widely used SDM model.
Methods:
Using a qualitative storytelling approach, we collected narratives from 10 PwOA and 7 physiotherapists in the Netherlands. Participants shared personal narratives of lived experiences ("stories") related to SDM in physiotherapy practice, resulting in 144 unique stories, of which 118 were related to decision-making and included for further analysis. These stories were analyzed through a seven-phase thematic analysis by a multidisciplinary research team (n = 12). Themes were plotted onto the SDM model of Moore and Kaplan.
Results:
Analysis revealed six main themes: Decision-making as a reciprocal process (four aspects, 51 stories); Influence of patient expectations on decisions (four aspects, 48 stories); Communication and information provision (two aspects, 39 stories); Patients' voice and identity (three aspects, 33 stories); Relationship between patient and healthcare provider (two aspects, 26 stories); External factors influencing decisions (two aspects, 23 stories). Twelve aspects were shared by both PwOA and physiotherapists, one was exclusive to PwOA, and four were unique to physiotherapists. All aspects fit within Moore and Kaplan's SDM model; 12 aligned with specific stages, while five spanned multiple stages.
Conclusions:
The study unravels the complex nature of SDM in physiotherapy. Storytelling revealed that factors like (power) dynamics as well as the physical environment seem to influence decision-making. Explicitly addressing these dynamics might provide opportunities for strengthening theoretical SDM models, clinical training, and SDM in real-world practice.
Practice Implications:
Greater attention to relational dynamics, patient expectations, and context have the potential to enhance the quality of SDM between PwOA and physiotherapists.
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