As a therapist engaging in person-centered rehabilitation, having commonly shared treatment goals with patients is the overall objective. Occasionally though, you come across a stubborn, reluctant, or uncooperative patient that doesn’t want to adhere to your proposed treatment of care.

Ethically, you have two choices:

  1. Accept the patient’s right to decide
  2. Use other strategies to encourage them to agree to the treatment goals

While the first option seems like the easiest choice, as a therapist, it is imperative to strike a balance between your therapeutic view and the patient’s best interest, against the ethical responsibility of autonomy of the patient.

It is a difficult situation, especially in cases of rehabilitation where people are vulnerable. In many cases, people are faced with pressures because their health has been impacted and this dramatically reduces their freedom to make decisions. And often they find themselves in foreign environments, surrounded by foreign people, which all influences their experience and the way they respond.

Certainly, you do have to keep their position, experiences and wishes in mind, but according to research, there are common ways that therapists can ethically communicate in such situations.

These include:

  1. Persuasion
  2. Inducements
  3. Interpersonal leverage
  4. Threats
  5. Deception as a form of threat
  6. Compulsion

The only two covered here are persuasion and inducements, as these are both considered the most effective forms of communication. Communication that still respects the autonomy of the patient. While the other forms of communication are thought to either be coercive or more ethically problematic.

dealing-with-the-reluctant-patient Communicating with Reluctant Patients in Rehabilitation

Persuasion

This is the best strategy for preserving a patient’s autonomy.

To persuade an individual, the therapist must disclose as much information as possible and provide reasoning that assists the patient to make a better choice for themselves.

For example:

You really do need to get out of bed today Mr F. Getting moving is going to help prevent clots and speed up your recovery so you’ll be able to get home faster.

With persuasion, you are trying to demonstrate and educate the patient about the benefits and risks f their decisions. If the patient still refuses, be patient and try to renegotiate again at a different time. You might also try adjusting the goals to accommodate patients so at least you can get them motivated towards something.

Inducements

Inducements also preserve the patient’s capacity to be autonomous.

They are generally rewards-based communications.

For example:

Mr. F, if you get out of bed and walk to the door, I’ll go organize those cookies you really wanted for afternoon tea.

The inducement is a suggestion based on something that will not see the patient worse off as a result. With the example above, Mr F won’t be worse off without his cookies, but since he loves them so much, having a small achievable goal may help motivate him toward action.

Using a persuasion and inducement together can also be an effective communication strategy.

As a therapist, every situation you’re presented with will require moral evaluation and consideration to ensure you reach a decision that helps support the patient’s autonomy. But at the same time you also need to consider the importance of meeting their needs of treatment, along with meeting the objectives of the organizational environment and procedures.

Most importantly, even though you can use your powers of persuasion, you still need to provide person-centered care that is ethically based.

You can view the full paper, published in the Journal of the American Physical Therapy Association, to learn more about the other forms of communication that are best avoided.

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