Background.Occupational therapists working in hospitals are confronted with increasingly complex discharge decisions. However, the relationship of discharge-planning strategies to the professional concepts of client-centred practice and enabling occupations has been unclear.Purpose.This study explored the relationship between the models of decision-making used by occupational therapists, and the professional issues of enabling occupation and client-centred practice.Methods.Qualitative interviews were conducted with 10 occupational therapists. Data were analyzed for the presence and emergence of themes.Results.Therapists try to balance the sometimes competing issues of safety and autonomy. Therapists often engage in negotiated decision-making. However, clients are sometimes excluded, despite therapists' commitment to client-centred processes. Consideration of occupations is often neglected.Practice Implications.Client-defined models of decision-making are insufficient for frail, cognitively- impaired people. A new, client-centred Negotiated Model of Decision-Making is proposed, which facilitates decisions to enable older people with their occupations.
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