title: Clinical decision making, risk and occupational therapy.
abstract: Little is known about the processes involved in risk taking, and complex decision making of the type encountered on acute medical wards in general hospitals. The purpose of the present study was to examine certain of these processes in the context of decisions to discharge elderly inpatients from hospital. Vignettes of hypothetical frail and disabled elderly in-patients were presented to student and qualified occupational therapists (OTs). All the vignettes represented high risk discharges and each of the patients expressed the desire to return to their own home. The additional diagnosis of early dementia was manipulated within and between vignettes. Subjects were asked to decide on the appropriateness of discharging each patient to (a) home and (b) a residential or nursing home. In addition, subjects completed a short demographic questionnaire which also probed aspects of their knowledge about elderly people. Results indicated that qualified OTs were less likely to overrule patients' wishes by favouring discharge of patients to residential or nursing home, and more likely to favour discharge to patients' own homes than student OTs. There was no overall main effect of dementia on subjects' decisions. In addition to clinical experience, certain areas of knowledge about elderly people were significantly associated with different approaches to risk taking in response to the vignettes. Undergraduate syllabi may need to be modified to incorporate more information about elderly people, the prevalence of different diseases, and direct experience of clinical decision making in the context of uncertain and risky situations.
authors.affiliation: Elderly Care Unit, St Thomas' Hospital, London, UK.
authors.forename: S.
authors.initials: S
authors.lastname: Reich
authors.forename: C.
authors.initials: C
authors.lastname: Eastwood
authors.forename: K.
authors.initials: K
authors.lastname: Tilling
authors.forename: A.
authors.initials: A
authors.lastname: Hopper