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Table 2 Transcript Quotes Demonstrating the Underlying Tensions to the Extremes of SDM Experience in Community Rehabilitation

From: Experiences of shared decision-making in community rehabilitation: a focused ethnography

Underlying TensionsWhere an interaction falls along the above spectrum relates to an interplay of these (not mutually-exclusive) tensions for patients and providers (the parties).
To Presuppose VS To Explore“Times [when] it doesn’t go well would be when maybe patient expectations and maybe my abilities don’t match particularly well at certain times.” [Rural Provider 4, Male]
“I’m not working. And I’m paying all this money and I don’t feel like I’m getting better and I want to. … But how come nobody’s helping me to read again, or to work on a computer so I can do my job? So sometimes I think, she’s in a rush. And she’s hard to see and I guess she intimidates me a little bit.” [Metropolitan-Urban Patient 2, Female]
VS
“I find the assessment being a little more focused and a lot faster if I spend a lot more time on the introduction and the question and ask them what are they here for and explain what we can do.” [Regional-Urban Provider 2, Female]
“What I was doing at work. … That was all taken into consideration. ‘What are you doing?’ … So, it’s working around that and creating a plan that is beneficial so that anything I do at work is not going to affect my rehab. And my rehab isn’t going to overload what I do at work, or vice versa. [Metropolitan-Urban Patient 4, Male]
Tell/Do VS
Ask/Listen
“At this point I think I know what’s best for people, but I always try to ask if we’re missing something …. I tell them you’ve got to let me know if this is not enough or too much or whatever it may be.” [Regional-Urban Provider 4, Male]
“There was some appointments that I felt like they were just doing what they had previously. … And I kept saying nothing’s really changing…. But that person never thought well maybe we should try something different. And I found that frustrating.” [Rural Patient 7, Female]
VS
“As a clinician I’m looking at everything from the clinical aspect right, but as the patient they’re looking more from the functional aspect. And I see the client only once a day probably for an hour, but they’re the ones who are living the day to day life. … So that’s where the shared decision is, we’re going to work on this, …this is going to help you in achieving this functional goal you have set for yourself, are you okay with that?” [Regional-Urban Provider 6, Female]
“We’re always maybe a little disappointed with some of the other professions and some of the health staff at the lack of communication and the lack of putting out all the options to everybody. Even when they do have communication difficulties, they’re still able to make that decision right?” [Regional-Urban Provider 3, Female]
Explanation VS
Education
“Sometimes I thought that they were understanding what I was saying whereas sometimes they’re not. They didn’t understand everything fully and you don’t know that sometimes until they come back.” [Rural Provider 3, Male]
“So the only thing that I can say is that a more formalized plan would be … written down, [and it] would give you the ability to go back and say okay when you came to see me in January this year we were working on your back and neck and now we’ve moved to your shoulder and your pecs, so are these connected or are they not connected?” [Metropolitan-Urban Patient, Female]
VS
“So my best one’s are more where we kind of work together and have a conversation rather than just ‘okay I’m going to stand up and just lecture you on what you’re going to do.’ It’s all back and forth right even throughout the day. There’s lots of questions I’m asking, it’s not just on how does it feel…”[Male, Provider 4, Regional-Urban]
“They’re all very good. They explain the bone or the muscle or whatever it is and what it does and what you should do and what you shouldn’t do, to try to let it heal.” [Regional-Urban Patient 1, Female]