Listed below are six contributing factors that influence an OT’s decision-making processes (VanderKaay et al., 2020). The factors have been expanded upon with relevant practice examples. Consider each one as it relates to the situation.
Client and Family
Remaining client centered sometimes requires occupational therapists to recognize the push and pull that can exist when attempting to respect both the autonomy and the safety of the client. Influencers such as client goals, preferences, lived experience,
values, beliefs, and desired quality of life (van Bruchem-Visser et al., 2020) need to be articulated in the decision-making process. Clients and families want to have open and transparent discussions in this partnership involving their healthcare.
Example: The client wants to continue driving so he can remain living at home. The daughter recognizes the importance for his quality of life and sense of purpose. For safety reasons she insists on accompanying her father when driving, but
the client prefers to drive alone.
Organization and Practice Setting
If occupational therapists are part of an organization, there may be guidance that sets out the expectations for certain types of situations, including policies or other guiding resources (for example, clinical decision-making tools or support processes).
There may also be decision-making factors related to the wider healthcare system for consideration, for example, funding allotments for service, or principles of health equity and access to service.
Example: The occupational therapist refers to the organization’s Managing Risk tool.
Theories and Evidence
Occupational therapists are expected to use theories and evidence to inform decision, including those based in ethics. Theories are used to guide, plan, address issues, and support decisions, for example, what are the best practices given the situation,
risks, and client factors.
Ethical decisions do not usually present with a simple, or ideal, course of action. Occupational therapists often face ethical dilemmas where there is no clear or right answer. As occupational therapist grapple with the facts of the situation and
the weighty implications of their decisions, they can look to the Code of Ethics which describes the fundamental values of respect and trust. Within each of these values, the Code of Ethics outlines key principles to
help occupational therapists identify important factors to consider and guide possible actions to take.
Example: The principle of respecting autonomy requires the occupation therapist to think about the client’s right to make their own choice and in this situation the client wants to keep driving even though
it may pose a risk. At the same time, the occupational therapist is held accountable for their assessment as well as actions to lessen the likelihood of these safety risks occurring. Accountability and communication prompt
the occupational therapist to discuss the safety concerns with the client and his daughter. The occupational therapist explains the decision to submit a discretionary report and the client has a chance to express his thoughts and to have his concerns
addressed.
Professional Regulations
Occupational therapists will find out about any regulatory requirements that apply to the situation. The College’s Code of Ethics, the Essential Competencies, and the College’s Standards for Practice describe the required expectations
for the day-to-day practice of occupational therapists. Other guidance is available for specific occupational therapy situations, such as the resource to the Child, Youth and Family Services Act for occupational therapists wanting
to know more about the obligations for reporting a child who may need protection.
Example: In this case, the occupational therapist reviews the College’s document on Discretionary Reporting of Fitness to Drive.
This orients individuals to the legislation, accountabilities, and other key information, such as documentation, consent, and privacy.
Healthcare Team
While occupational therapists are accountable for their own professional decision-making, others, such as those in the circle of care, can add valuable perspectives and contribute to the reasoning and decision-making process.
Discussing thought-provoking questions, clarifying facts, and generating options can help to talk through and narrow the course of action to be taken.
Example: The occupational therapist can bring up the situation at clinical rounds or speak separately to interprofessional team members for input. Perhaps this issue is already being addressed or monitored by another member of the healthcare
team, such as the treating physician.
Law
Certain pieces of legislation directly impact specific aspects of occupational therapy practice. Examples of such legislation include the Child, Youth and Family Services Act, 2017; Health Care Consent Act, 1996; Regulated Health Professions Act, 1991; Personal Health Information Protection Act, 2004, and Highway Traffic Act 1990.
Example: The occupational therapist reviews a section of Ontario Regulation 340/94: Drivers’ Licences made under the Highway Traffic Act, 1990, “14.2 For the purposes of subsection 203 (2) of the Act, the following
are the prescribed persons who may report under that subsection: an occupational therapist, an optometrist, a nurse practitioner and a physician.” This confirms that occupational therapists are able to report concerns about a client’s
fitness to drive directly to the Ministry of Transportation.