Background
At the crux of patient centred care is Shared Decision Making (SDM), which benefits patient and practitioner. Despite external pressures, studies indicate that SDM remains poorly practised across a variety of healthcare professions. The degree of SDM engagement within United Kingdom osteopathic undergraduate teaching clinics is currently unknown.
Methods
In 2014 we used the reliable and validated OPTION-12 (O12) instrument to calculate a score that reflected the degree of SDM utility in one United Kingdom Osteopathic Educational Institute’s teaching clinic. We also aimed to compare these scores with those previously obtained for physiotherapists working within the United Kingdom’s National Health Service. Student-patient initial and follow-up encounters were audio recorded, transcribed and scored using the O12. Comparisons between the following O12 scores were performed: the Osteopathic Educational Institute’s 4th and 3rd year students; the Osteopathic Educational Institute’s student’s initial and follow-up patient encounters; the Osteopathic Educational Institute’s students and National Health Service physiotherapists.
Results
We analysed 35.5 h of transcribed data from 30 student-patient encounters (7 initial: 23 follow-up). An O12 score of 0.6% (range 0–10.4%) was calculated. No significant differences were found between year groups or encounter types. Significant differences were found compared to National Health Service physiotherapist (score = 24.4%): (U = 144, z = 4.25,
p
< 0.0005); although both scores are below the 60% threshold for competent SDM behaviour.
Conclusions
Undergraduate osteopaths did not appear to engage in competent SDM behaviours, implying traditional and paternalistic styles of decision making that align with results from other manual therapy professions. Students in this study did not practise competent SDM behaviours. Effective educational strategies are required to ensure SDM behaviours reach competent levels.
In a questionnaire survey 71/96 members of the Belfast branch of the Parkinson's Disease Society reported their use of existing aids and their need for new aids. They selfrated their disability over a wide range of day-to-day functions, including transferring and turning in bed, selfcare, general mobility, independent living and communication. Thirty-one people had a particularly helpful aid. Only 16 people mentioned problems where a new aid might be helpful, but a number of these were already available. Comments were in general not about aids but rather the need for therapy, problems with drugs and the variability of the disease. Large numbers of patients were dependent in many daily tasks including 55% and 44% respectively needing help to bathe and dress. 31 % were dependent walking indoors and 73% could not use public transport by themselves. Clues to both the usefulness and limitations of aids were provided and require further exploration. There is a need for an overall support strategy in which expert assessment of daily living tasks and the provision of appropriate aids can play an important part. Doctors, therapists and patients all require more information on these topics.
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