A qualitative study to explore the decision-making and clinical reasoning processes among experienced pelvic health physiotherapists in the United Kingdom and the Kingdom of Saudi Arabia while managing patients with urinary incontinence

Abstract

Urinary Incontinence can significantly affect (and be affected by) different aspects of a patient’s life and can be a chronic and recurrent disease that may require self management; this may lead to unique clinical reasoning by pelvic health physiotherapists. Clinical reasoning is complex in nature and can be represented by different models that may overlap with each other in terms of their terminology and meaning. The existing bio-psychosocial model is limited and has weak implementation in the current literature. Also, the clinical reasoning of physiotherapists working within different countries and organisational cultures are likely to differ. However, there is a lack of research regarding the influence of different cultures and other factors, such as patients’ social and organisational factors, on physiotherapists’ clinical reasoning processes and the factors that might affect their decision making. This study aims to explore the clinical reasoning process and decision making of physiotherapists in the United Kingdom (UK) and the Kingdom of Saudi Arabia (KSA) while assessing and treating patients with urinary incontinence. Using qualitative research that involved focus groups and interviews with experienced physiotherapists in the UK and KSA. A framework approach to analysis was used to explore and interpret findings. A total of 28 participants were recruited from both countries to undertake semi-structured interviews to understand their thinking processes while managing patients with urinary incontinence. Another 20 participants were recruited to discuss the factors influencing physiotherapists’ decision making across three focus groups in both countries. The results showed four main themes: 1) contextual factors (culture, resources, and healthcare system), 2) Physiotherapists’ factors (multifaceted knowledge and experience, interpersonal characteristics and dealing with complex emotional and ethical issues), 3) patients’ factors (patients’ characteristics and expectations) and 4) making sense of physiotherapists’ clinical reasoning and decision making. The existing models of reasoning are insufficient on their own because they do not include individual and organisational cultures. Sense making theory was used to interpret the vi participants’ thinking process because it helps in understanding ambiguity and uncertainties; in addition, it considers organisational cultures. Comparing two different countries increase understanding of the influence of individual and organisational cultures on decision making. Introducing sense making theory, institutional logics and cultural humility assist in understanding physiotherapists’ clinical reasoning and decision making in the UK and KSA while managing patients with urinary incontinence. The findings of this study can be relevant to physiotherapists’ clinical reasoning and decision making in other chronic conditions. Further studies are needed to explore the effect of adding cultural humility to cultural competency in physiotherapists’ management plans of ethnic minority patients within the UK.

More information

Identifiers

ORCID for Ellen Kitson-Reynolds: orcid.org/0000-0002-8099-883X

Catalogue record

Export record