Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug;27(4):e14162.
doi: 10.1111/hex.14162.

A New Process Model for Relationship-Centred Shared Decision-Making in Physical Medicine and Rehabilitation Settings

Christina Papadimitriou  1 , Marla L Clayman  2 , Trudy Mallinson  3 , Jennifer A Weaver  4 , Ann Guernon  5 , Albert J Meehan  6 , Trisha Kot  7 , Paige Ford  7 , Roger Ideishi  8 , Christina Prather  9 , Philip van der Wees  3
Affiliations

A New Process Model for Relationship-Centred Shared Decision-Making in Physical Medicine and Rehabilitation Settings

Christina Papadimitriou et al. Health Expect. 2024 Aug.

Abstract

Introduction: We present a relationship-centred shared-decision-making (RCSDM) process model to explicate factors that shape decision-making processes during physical medicine and rehabilitation (PMR) encounters among patients, their care partners and practitioners. Existing shared decision-making (SDM) models fall short in addressing the everyday decisions routinely made regarding persons with chronic disabilities who require high levels of support, their care partners and rehabilitation practitioners. In PMR, these everyday decisions are small scale, immediate and in service to a larger therapeutic goal. They can be thought of as micro-decisions and involve multiple practitioners, care partners and patients. How micro-decisions are made in this context is contingent on multiple roles and relationships among these relevant parties. Our model centres on micro-decisions among patients, their care partners and practitioners based on our disorders of consciousness (DoC) research.

Methods: To develop our model, we examined peer-reviewed literature in SDM in PMR, chronic disability and person-centeredness; formed collaborations and co-created our constructs with rehabilitation practitioners and with care partners who have lived experience of caring for persons with DoC; analysed emerging empirical data and vetted early versions with expert scientific and clinical audiences. Our model builds from the core tenets of relational autonomy, and scholarship and activism of disability advocates.

Findings: Our model conceptualizes four non-hierarchical levels of analysis to understand the process of micro-decision-making in chronic disability and medical rehabilitation: social forces (historical and sociological); roles and relationships (multiple and intersecting); relational dimensions (interactional and contextual) and micro-decision moments (initiation, response and closure).

Discussion: Relationships among patients, their care partners and practitioners are the intersubjective milieu within which decisions are made. Our conceptual model explicates the process of micro-decision-making in PMR.

Patient or public contribution: Care partners (or caregivers) and rehabilitation practitioners are active members of our team. We work together to develop research projects, collect, analyse and disseminate data. The conceptual model we present in this manuscript was co-created-input from care partners and practitioners on previously collected data became the impetus to develop the RCSDM process model and share co-authorship in this manuscript.

Keywords: physical rehabilitation; relationship‐centred care; shared decision‐making.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic representation of the relationship‐centred shared decision‐making process model.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Papadimitriou C., Mallinson T., Weaver J., et al., “Proposing a Relationship‐Centered SDM Process Conceptual Model for Chronic Disability,” Patient Education and Counseling 109 (2023): 11, 10.1016/j.pec.2022.10.035. - DOI
    1. Pape T., Weaver J., Papadimitriou C., et al., “No One Listens to Me: Working With Caregivers to Listen to Their Caring Experiences,” Archives of Physical Medicine and Rehabilitation 100, no. 10 (2019): e102–e103, 10.1016/j.apmr.2019.08.296. - DOI
    1. Papadimitriou C., Weaver J., Guernon A., et al., “Caregiver Perceptions of Their Communication With Rehabilitation Providers Who Treat Persons in Disordered States of Consciousness,” Archives of Physical Medicine and Rehabilitation 103, no. 3 (2022): e18, 10.1016/j.apmr.2022.01.048. - DOI
    1. Guernon A., Weaver J., Kot T., et al., “‘My Person’ or ‘A Person’: CarePartner and Practitioner Perceptions Caring for Persons in Disordered Consciousness,” Archives of Physical Medicine and Rehabilitation 103, no. 12 (2022): e80–e81, 10.1016/j.apmr.2022.08.639. - DOI
    1. Légaré F. and Witteman H. O., “Shared Decision Making: Examining Key Elements and Barriers to Adoption Into Routine Clinical Practice,” Health Affairs 32, no. 2 (2013): 276–284, 10.1377/hlthaff.2012.1078. - DOI - PubMed

Publication types

LinkOut - more resources