Abstract
IntroductionInvolving patients in decision making is a legal requirement in many countries, associated with better rehabilitation outcomes, but not easily accomplished during initial inpatient rehabilitation after severe trauma. Providing medical treatment according to the principles of shared decision making is challenging as a point in case for persons with spinal cord injury (SCI).ObjectivesThe aim of this study was to retrospectively explore the patients’ views on their participation in decision making during their first inpatient rehabilitation after onset of SCI, in order to optimize treatment concepts.MethodsA total of 22 participants with SCI were interviewed in‐depth using a semi‐structured interview scheme between 6 months and 35 years post‐onset. Interviews were transcribed verbatim and analysed with the Mayring method for qualitative content analysis.ResultsParticipants experienced a substantially reduced ability to participate in decision making during the early phase after SCI. They perceived physical, psychological and environmental factors to have impacted upon this ability. Patients mentioned regaining their ability to make decisions was an important goal during their first rehabilitation. Receiving adequate information in an understandable and personalized way was a prerequisite to achieve this goal. Other important factors included medical and psychological condition, personal engagement, time and dialogue with peers.ConclusionDuring the initial rehabilitation of patients with SCI, professionals need to deal with the discrepancy between the obligation to respect a patient's autonomy and their diminished ability for decision making.
Highlights
Involving patients in decision making is a legal requirement in many countries, associated with better rehabilitation outcomes, but not accomplished during initial inpatient rehabilitation after severe trauma
But when I took the first decision myself, it may have begun with trying to feed myself... as a quadriplegic..., you have an ordinary life, and you are suddenly thrown out of it—and you cannot move anything, ... you are completely dependent on others, so you give up all responsibility
This study provides information on how to support the patient’s decision-making ability after a newly acquired spinal cord injury (SCI), delineating factors which may hinder or facilitate the ability to make decisions from the patient’s perspective
Summary
Involving patients in decision making is a legal requirement in many countries, associated with better rehabilitation outcomes, but not accomplished during initial inpatient rehabilitation after severe trauma. Objectives: The aim of this study was to retrospectively explore the patients’ views on their participation in decision making during their first inpatient rehabilitation after onset of SCI, in order to optimize treatment concepts. Results: Participants experienced a substantially reduced ability to participate in decision making during the early phase after SCI. They perceived physical, psychological and environmental factors to have impacted upon this ability. Patients mentioned regaining their ability to make decisions was an important goal during their first rehabilitation. Conclusion: During the initial rehabilitation of patients with SCI, professionals need to deal with the discrepancy between the obligation to respect a patient’s autonomy and their diminished ability for decision making
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