Table 1 Tensions Underlying SDM Experiences in Community Rehabilitation

To Presuppose VS To Explore

Preconceived assumptions stymie overtures and opportunities to learn from each other. Patients and providers seem to treat each other as obstacles to overcome not partners. Relationships lack traits of optimism, confidence, safety or motivation.

VS

There is awareness and divestment of preconceived notions. Collaboration is fostered by humility, inclusivity and feelings of safety. Awareness, availability, candour and respect typify interactions.

Tell/Do VS Ask/Listen

The provider mostly tells the patient what to do. Patients get few choices. Patients cannot, or will not, share their perspectives. Misunderstandings become frequent.

VS

Questions are posed. Responses are listened to and acted upon accordingly. Few limits (both internal and external) impede patient expression (e.g. ability to vent).

Explanation VS

Education

Providers unilaterally share information to secure permission and adherence. Information is not personalized and at times confusing. Patients can be intimidated.

VS

Providers use knowledge to empower patients and support informed decision-making. Language is clear, consistent, realistic and patient-specific.