Recommending 24-hour attendant care: A qualitative study exploring the clinical decision-making process of occupational therapists in Ontario, Canada

ObjectiveThis study aims to explore how occupational therapists working in private practices in Canada use clinical indicators and tools to determine if clients require 24-hour attendant care.DesignA qualitative research study.SettingThe setting involved semi-structured, one-on-one interviews with occupational therapists in Canada.ParticipantsOccupational therapists were selected through purposive sampling: (1) registered Canadian occupational therapists, (2) with over 10 years of private practice experience, and (3) who have assessed the need for 24-hour attendant care at least once before the study.Main measuresThe interviews were conducted, transcribed, coded, and thematically analyzed by two researchers using Braun and Clarke's protocol. The paper is also reported based on the consolidated criteria for reporting qualitative research guidance.ResultsThe study involved nine occupational therapists (eight women and one man), with 14 to 24 years of private practice experience in Ontario. Three main themes in the decision-making process for 24-hour attendant care were identified: (1) Individualized and Holistic Assessments; (2) Clinical Expertise-Based Decision-making; and (3) Risk Assessment in Decision-Making.ConclusionsThis study provides a greater understanding of the decision-making process of occupational therapists working in Canada when recommending 24-hour attendant care. However, further research and development of guidelines are needed to support occupational therapists in this area.