Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study

My conclusion is you don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION, DO YOU? You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study

Amanda Gahlot ¹ Grace Richardson ¹ Patricia Librea ¹ Grace Kim ^1,2*

• ¹ New York University, New York City, United States
• ² NYU Langone Hospital-Long Island, Mineola, New York, United States

The final, formatted version of the article will be published soon.

Purpose: 

To explore the attitudes and experiences of clinicians and individuals with chronic stroke on the use of shared decision-making (SDM) during upper extremity rehabilitation to improve daily arm use in the home environment. Specifically, we aimed to describe clinician and client perspectives regarding the facilitators and barriers to using SDM within the context of a self-directed upper extremity intervention for individuals living in the community with chronic stroke. 

 

Methods: 

Data were collected within the context of an interventional study examining the feasibility of the Use My Arm-Remote intervention. Focus group interviews were conducted with the clinicians (n=3) providing the intervention and individual semi-structured interviews with the participants (n=15) of the study. All interview data were collected after the end of the intervention period. Data were analyzed using thematic analysis. 

 

Results: 

The following themes were identified: 1) Equal partnership; 2) Enhancing clinician confidence; and 3) This is different. Facilitators and barriers were identified within each theme. Key facilitators for clinicians were competence with SDM and patient characteristics; while facilitators for patients were open and trusting relationships with clinicians and personalized experience. Key barriers to SDM for clinicians were lack of expertise in SDM and participant buy in; while patients identified a lack of foundational knowledge of stroke rehabilitation(Yeah, your survivors have identified that their stroke medical 'professionals' know nothing specific about recovery!)as a potential barrier. 

Conclusions: 

Key barriers were analyzed using the consolidated framework for advancing implementation science to interpret results and identify strategies for enhancing the implementation of SDM in a virtual setting. The CFIR-ERIC tool highlighted the need for targeted educational meetings and materials to address the training and educational needs of both clinicians and patients for future iterations of this intervention.

Keywords: Motivational Interviewing, stroke rehabilitation, shared decision making, telehealth, Upper Extremity

Received: 09 Apr 2024; Accepted: 04 Sep 2024.

Copyright: © 2024 Gahlot, Richardson, Librea and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Grace Kim, New York University, New York City, United States

Stroke Survivors' Experiences and Needs during the Decision-making Process Considering Rehabilitation Options: A Pilot Descriptive Study in Japan

My conclusion from this is that you take away any decision making by the patients. You provide 100% recovery protocols and there is no decision making by either the doctors, therapists or patients. SOLVE THE CORRECT PROBLEM! 100% RECOVERY PROTOCOLS!

Stroke Survivors' Experiences and Needs during the Decision-making Process Considering Rehabilitation Options: A Pilot Descriptive Study in Japan

Kaori Muraoka, MD, PhD a Yoshiyuki Takimoto, MD, PhD b Eisuke Nakazawa, PhD b Tetsuya Tsuji, MD, PhD c and Meigen Liu, MD, PhD

 

Objectives: 

 

The purposes of the present study were to describe stroke survivors’ experiences and to identify their support needs when faced with decisions about rehabilitation. 

 

Methods: 

 

Based on the Ottawa Decision Support Framework needs assessment, semi-structured interviews were conducted with 15 stroke survivors. The degree of participation in decision-making and anxiety were assessed quantitatively. All interview transcripts describing their experiences and emotions were qualitatively analyzed. 

 

Results: 

 

All participants had hemiplegia but could perform their daily activities unassisted. Most participants played an active role in decision-making, but 13 patients felt some anxiety when choosing chronic-phase rehabilitation programs. Qualitative analysis identified 19 codes, of which 13 were categorized into the four factors of knowledge, values, certainty, and support. The codes related to patient feelings of anxiety and insecurity about making decisions were “lack of information about options,” difficulty in “selecting appropriate information,” and “lack of support” from medical staff. Trustworthy specialist support and prior knowledge of rehabilitation were identified as factors that could help patients feel more secure about making decisions. 

Conclusions: 

 

To support stroke survivors in their decision-making about rehabilitation, each patient should be given a long-term perspective on stroke rehabilitation and sufficient information on rehabilitation options tailored to their individual needs. Decision aids for stroke survivors built on these findings will be used in clinical practice, and their efficacy will be verified in future studies

AI Enhanced Person-Centred Care Services for Monitoring Stroke Outpatient Rehabilitation

Shared decision making is only useful  if your provider stops trying to dumb down your goal of 100% recovery by invoking the tyranny of low expectations to what the hospital can provide. The hospital has known for decades that their stroke rehab is a complete fucking failure and has done NOTHING to correct that. The board of directors needs to be fired for allowing incompetence to be standard fare.

AI Enhanced Person-Centred Care Services for Monitoring Stroke Outpatient Rehabilitation

Informatics and Technology in Clinical Care and Public Health
J. Mantas et al. (Eds.)
© 2022 The authors and IOS Press.
This article is published online with Open Access by IOS Press and distributed under the terms
of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0).
doi:10.3233/SHT1210849
Ramo ŠENDELJ a,1
, Ivana     a


    b and Dalia c
aUniversity of Donja Gorica, Montenegro
bDepartment of Neurology, Clinical Centre of Montenegro cVilnius University, Lithuania

Abstract. 

Development of person-centred care (PCC) services require adjustment
to specific domain of application and integration with existing processes
implemented in healthcare institution. This poster present PCC services for
monitoring stroke outpatient rehabilitation, enhanced by modern ICT technologies
(thus enabling adjustments to different kind of patients, which is especially relevant
due to potential consequences of the stroke and caused degree of disability).
Keywords. person-centred care services, tool support, stroke rehabilitation

1. Introduction

The PCC as innovative approach in health care has attracted attention as a proven concept
for improvement of health outcomes by advancing cooperation and shared decision
making between doctors and patients, with simultaneous increase of patient satisfaction
[4][1]. Development of PCC services for stroke outpatient rehabilitation follows the
following specific characteristics [3]: it is a chronic condition and thus the whole cycle
of recovery is needed to be covered, after hospital treatment special focus shall be put on
rehabilitation and further prevention of recurrent stroke through increased quality of life,
self-efficacy, etc. The developed services are elaborated over evidence from neurology
department of Clinical Centre in Montenegro, within scientific research project which is
funded by the Ministry of Science of Montenegro. 

 

More at link.

 

Many medical decisions require shared decision making

This comes from KevinMDs blog. This should be extremely applicable to us in our rehabilitation journey. The problem is that there is no factual basis for  our therapies. we should be able to get something like;
This therapy has a 20% success rate when followed for 3 months.
vs. this therapy has a 50% success rate when followed for 6 months.
Until we get to that level of knowledge everything we do is just a shot in the dark. We can't accept the standard reply, 'All strokes are different, all stroke recoveries are different'. Thats just pure laziness on whomever said that to you.
http://www.kevinmd.com/blog/2012/04/medical-decisions-require-shared-decision-making.html