A grounded theory of osteopathic clinical decision-making and therapeutic approaches - Implications for osteopathic education

Osteopaths have relied upon the philosophical and theoretical foundations upon which the profession was built to guide clinical practice. However, there is limited research-based knowledge of how osteopaths make decisions in relation to clinical practice.
The presentation offers an explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths in the UK, using a grounded theory framework, employing semi-structured interviews, observation and video-recording of patient appointments.
Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants’ therapeutic approach influenced their clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants’ overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants’ conception of practice.
The increasing emphasis on shared-decision making challenges the traditional practitioner-centred approaches of osteopathy which focus on practitioners’ hands-on skills combined with their knowledge and decision-making.
Undergraduate osteopathic curricula need to be developed to reflect this shift in healthcare focus. Approaches to decision making which are shared and patient-led, need to be explicit and incorporated into osteopathic undergraduate education, so that students can develop their own decision-making capabilities which are patient-centred. Failure to meet patient demands and expectations may result in a lack of ability to compete in the current landscape and culture of modern healthcare which promotes higher levels of patient involvement in the decision-making process.

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Dr Oliver Thomson PhD, MSc, BSc (Hons), DO is a practicing osteopath and member of the BSO research department, where he leads the research units for the pre-registration osteopathy courses. He has lectured and tutored osteopathic students in the UK and throughout Scandinavia. Oliver completed his PhD which used constructivist grounded theory to explore the clinical decision-making of experienced osteopaths. He has authored several research papers on clinical decision-making/reasoning, qualitative research and grounded theory.

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