Abstract
Background/Purpose: Evidence-based practice and patient-centred care are prominent models of contemporary rehabilitation. Both emphasize patient values, preferences, and circumstances as integral to decision-making and care planning, enabling rehabilitation to be tailored to each person. Despite the value of integrating patient values, preferences, and circumstances into rehabilitation, how health professionals elicit these remains unclear.
Research Aims/Objectives: This research aimed to explore how patients’ values, preferences, and circumstances are elicited in inpatient rehabilitation, to develop a clinical education intervention informed by these findings, and to evaluate the feasibility of its implementation.
The four objectives explored in three phases were to:
1. Explore what rehabilitation professionals understand by ‘patient values,’ ‘preferences,’ and ‘circumstances’ (Phase 1).
2. Explore how health professionals elicit and share this information in inpatient rehabilitation (Phase 1).
3. Understand stroke survivor and family perceptions of elicitation and integration of values, preferences, and circumstances during inpatient rehabilitation (Phase 2).
4. Develop and evaluate the feasibility of a professional development intervention for rehabilitation clinicians to enhance their elicitation of values, preferences, and circumstances in clinical practice (Phase 3).
Methods: A mixed-methods approach comprised three research phases. Phase 1 (objectives 1 and 2) used an exploratory qualitative descriptive study and interviews with clinicians (n=13) from interprofessional rehabilitation teams in New Zealand. Phase 2 (objective 3) was also a qualitative descriptive approach using interviews with stroke survivors (n=10) and family members (n=2) who had recently participated in inpatient rehabilitation in New Zealand. Interview data were analyzed using a general inductive approach. Phase 3 systematically developed an evidence-based and theory-informed clinical education intervention guided by the Theoretical Domains Framework and Behaviour Change Wheel. The feasibility of implementing this intervention was subsequently evaluated by an interprofessional rehabilitation team in Canada (n=5).
Key findings: Clinicians understood ‘values’ to mean what is meaningful and important, ‘preferences’ as choices and likes/dislikes, and ‘circumstances’ as the physical, environmental, and social context surrounding the person. Information was gathered directly from patients or indirectly from other sources (e.g., other clinicians) using formal and informal strategies. Eliciting and communicating information relied on relationships and many contributions. Tailoring the approach for each person optimizes elicitation.
Stroke survivors and families felt that health professionals’ understanding of them ‘as a person’ shaped their stroke and rehabilitation experience. Relationships and communication, as well as organizational and clinician priorities, influenced how and how much, clinicians got to know them. Survivors and family desired to be seen and valued as individuals as they navigated the unknown post-stroke journey and self.
The interprofessional continuing professional development intervention was acceptable to rehabilitation clinicians and practical to implement in a busy inpatient stroke rehabilitation unit.
Conclusion: Understanding and integrating patient values, preferences, and circumstances is a dynamic and multi-faceted process relying on relationships, support, and communication among everyone involved. The strategies used, and the approach adopted to implement these strategies are essential to elicitation. These findings enriched resource design for clinical education, individual and team clinical practices, and organizational processes to improve rehabilitation engagement, patient-centred care, and, ultimately, patient outcomes.