Dissertation

Shared Decision Making in United States Home Care Physical Therapy

Moore, Cindy Lane

2022

Overview

Objective: Shared decision making (SDM) in physical therapy can improve patient outcomes and satisfaction but is underutilized. This study describes the views of home care physical therapists (PTs) regarding older adult patients’ participation in therapy goal setting and treatment planning. Methods: A convergent mixed methods approach was used. Physical therapists’ SDM knowledge, skills, attitudes, use, and barriers were surveyed in an online questionnaire informed by an SDM in physical therapy framework and two implementation science frameworks. Semi-structured interviews were analyzed using conventional content analysis, and a trustworthiness plan supported study rigor. Results: Surveys were completed by 220 PTs of varied age (range 27-76 years, mean 49.1 ± 11.58) and experience (range 1-49 years, mean 23.6 ± 12.32) who provided home care services to older adults in 44 states. Twenty PTs (80% female; mean age = 50.6, SD=12.7, range 28-73) representing all continental United States geographic regions with varied levels of geriatric (mean 24.2 years, SD=11.6, range 3-40) and home care (mean 15.7, SD=11.5, range 2-40) experience were interviewed. As measured by SDM-Q-Doc, SDM was present (adjusted score 70.0% ± 17.25) and correlated with 12 factors including respondents’ rating of their patients’ overall desired (r=.418, p<.001) and actual (r=.409, p<.001) levels of participation in goal setting. Therapists viewed SDM as beneficial and part of their professional role, but encountered patient, clinician, and organizational barriers to increasing its use. Missed opportunities for understanding and meeting patients’ needs and tensions between clinical judgments and organizational requirements were identified. A table of SDM barriers and strategies was constructed from the data and a conceptual model was developed to illustrate types and flow of goal and treatment decisions. Conclusions: Findings show room for increased SDM and suggest interventions addressing PTs’ professional role, their ability to collaboratively weigh treatment options, affirm shared decisions, and translate patients’ aspirational goals to goals into ones acceptable to regulators and payers. Home care physical therapy SDM frameworks, measurement tools, and interventions need to address goal setting as well as treatment planning, accommodate differences between setting patient and therapeutic goals, and acknowledge the role of actors beyond therapist-patient dyads.

• Publisher: ProQuest Dissertations & Theses
• Subject: Aging / Gerontology / Health care management / Individual & family studies / Physical therapy
• ISBN: 9798438739234