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Clinical decision making and therapeutic approaches of experienced osteopaths
Thomson, O. [51]

Journal: Unpublished PhD thesis University of Brighton, Date: 2013/04, Pages: 345, type of study: qualitative study

Free full text   (https://research.brighton.ac.uk/en/studentTheses/clinical-decision-making-and-therapeutic-approaches-of-experience)

Keywords:

clinical reasoning [56]
decision-making [11]
osteopaths [138]
practice [207]
qualitative study [209]
therapeutic process [37]
UK [80]

Abstract:

Clinical decision-making refers to the social, cognitive and interactive processes by which practitioners make choices in relation to the examination, diagnosis, treatment and management of patients. It is fundamental for effective and efficient clinical practice and is central to professional autonomy and accountability. As the profession continues to grow, osteopathy is playing an increasingly important role in musculoskeletal healthcare. While research has identified the clinical decision-making approaches taken by a range of healthcare professions, there is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. A total of twelve UK registered osteopaths participated in this qualitative study, situated in the interpretive research paradigm. Purposive sampling was used to initially select participants. Subsequent theoretical sampling, informed by data analysis, allowed specific participants to be sampled. Data was initially collected from twelve semistructured interviews with nine participants, which were audio-recorded. As the study approached theoretical sufficiency, a further three participants were observed and videorecorded during a patient appointment, which was followed by a video-prompted reflective interview. Toward the end of the study, two participants were theoretically sampled for a second interview, based on their conceptions of practice. A constructivist grounded theory approach involving the constant comparative method of analysis was used to code and analyse data to construct a substantive theory of osteopathic clinical decision-making and therapeutic approaches. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed, Treater, Communicator and Educator. The therapeutic approach adopted by practitioners influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and their therapeutic goals. Participants’ conception of practice, which lay on a continuum ranging from technical rationality to professional artistry, was identified as the key factor which contributed to their therapeutic approach. Practitioners’ conception of practice was influenced by their educational experience, view of health and disease, epistemology of practice knowledge, theory-practice relationship and their perceived therapeutic role. The findings indicate that there is variation in osteopaths’ therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. These findings provide the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths, and have implications for osteopathic practice, education and research.

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