The tensions between risk and choice: Perspectives of Australian occupational therapists about informed choice when working with older people

INTRODUCTION: Aged care in Australia is under scrutiny. In 2021, the Royal Commission into Aged Care Quality and Safety highlighted the need for increased informed choice. Occupational therapists working within residential and community aged care have a responsibility to provide informed choice to their clients. Knowing more about the perspectives of occupational therapists about informed choice with older people will provide insights into practice that may direct future training needs and best practice recommendations. This study therefore aimed to explore perspectives of Australian occupational therapists about informed choice when working with older people. METHODS: A qualitative descriptive research design was employed. Through purposive and snowball sampling, 10 Australian occupational therapists who work in the aged care sector were recruited. They worked in both residential and community aged care. Data were collected face-to-face and via tele-conferencing using semi-structured interviews; data were analysed using reflexive thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: Consumers of occupational therapy services were not involved, but this is a recommendation for future research. FINDINGS: The findings reflected tensions reported in the literature of managing multiple decision-makers and fluctuating decision-making capacity alongside professional responsibilities. Theme 1 described methods for raising client awareness of options, negotiating choices, exercising caution, and supporting dignity or risk. Theme 2 described the communication skills employed for promoting informed choice, and Theme 3 described the need for collaborative decision-making. The final theme outlined the value of workplace policies, procedures, and documents for informed choice. CONCLUSION: Occupational therapists in aged care approach their practice using a person and family centred lens. They employ skilful communication, negotiation, and problem solving. However, tensions exist between managing professional responsibilities around risk and supporting informed choice. Aged care is complex, with ongoing need for training and supervision, and a community of practice for idea sharing and collective problem-solving.