Complexities of shared decision-making in home-care physical therapy: a mixed methods study

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Health Services Research

Background:

• Shared decision-making (SDM) is crucial for patient-centered care but is underutilized in physical therapy.
• Limited information exists on how SDM is implemented in home care physical therapy settings.

Purpose of the Study:

• To describe the experiences of physical therapists with SDM during initial in-home evaluations for older adults.
• To identify strategies for enhancing SDM in this population and setting.

Main Methods:

• Convergent mixed methods design integrating anonymous surveys and volunteer interviews.
• 220 home care physical therapists completed surveys; 20 participated in interviews.
• Explored participants' experiences with SDM during in-home initial evaluations.

Main Results:

• SDM emerged as a 'Suite of Decisions' encompassing goal setting, treatment planning, and service administration.
• A second theme, 'Balancing Patients', Therapists', and Employers' Needs,' highlighted conflicts between patient advocacy and organizational demands.
• Practice dilemmas arose concerning reimbursement, treatment frequency authority, and care continuity.

Conclusions:

• SDM in home care physical therapy is intricate, influenced by contextual factors and potential ethical distress.
• Strategies to improve SDM can enhance patient engagement and satisfaction for both patients and therapists.