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An Exploration of the Decision Making Process Between Musculoskeletal Extended Scope Practitioners and their Patients

Thompson, Jonathan (2018) An Exploration of the Decision Making Process Between Musculoskeletal Extended Scope Practitioners and their Patients. Doctoral thesis, York St John University.

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Abstract

Extended Scope Practitioner (ESP) posts are well established in musculoskeletal services across the United Kingdom and in selected international settings. However, the evidence supporting their effectiveness and details of their interventions is limited, particularly in relation to the way ESPs interact with their patients, consider management choices and arrive at these decisions.

This thesis reports on research, which aims to address some of these gaps. A systematic review was undertaken to clarify the state of current knowledge and confirmed evidence surrounding decision making was lacking. The systematic review informed a subsequent qualitative study utilising a phenomenological approach to explore both patient and ESP experiences of decision making and the factors influencing this process.

Results demonstrated the complexities of the clinical relationship and how ESPs and their patients collaborate to enable patients to make informed healthcare decisions. Relationships are positive and productive, based upon a shared understanding and alignment of decision making preferences.

Effective communication, an awareness of patient expectations and influences acting upon both parties play an important role in decision making. The study provides new insight into the ways ESPs and patients interact to make appropriate decisions regarding musculoskeletal health. Decision making is most frequently undertaken as part of a collaborative shared style, showing ESP care is aligned to contemporary patient-centred and co-produced care.

Details of how ESPs consider the stresses and risks of their advanced roles have been uncovered, alongside ways in which these stresses may be managed.

There is also insight into how ESP staff develop into their roles and consider the clinical competencies required to practice safely, transitioning from a traditional allied health professional role to an advanced practitioner.

The results provide important advances in evidence for advanced practitioners, patients with MSK conditions, healthcare organisations and policy makers.

Item Type: Thesis (Doctoral)
Status: Unpublished
Subjects: R Medicine > RM Therapeutics. Pharmacology > RM695 Physical therapy. Occupational therapy
School/Department: School of Health Sciences
URI: http://ray.yorksj.ac.uk/id/eprint/3523

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