Schematic representation of the Relationship-Centred Shared Decision-Making process model.

People receiving physical rehabilitation often face daily care choices that are deeply personal and sometimes difficult to navigate, especially when they have trouble speaking or thinking clearly. These smaller choices, known as “micro-decisions”—meaning immediate care choices made during clinical interactions—are usually not acknowledged in traditional healthcare training as important. Recognizing this issue, a group of researchers created a new approach that is designed to better understand choices during clinical interactions. Their approach started by analyzing video interactions and proposed a process model called the Relationship-Centred Shared Decision-Making Process Model. This model looks closely at how people involved in care—patients, their family supporters, and healthcare workers—work together.

Dr. Christina Papadimitriou from Oakland University, along with her close collaborator Dr. Trudy Mallinson at George Washington University, and Dr. Marla Clayman at the Veterans Health Administration Center for Health Optimization & Implementation Research, developed this model to improve the care of persons who need high levels of support, such as persons with chronic illness or disabilities. Their findings were published in the peer-reviewed journal Health Expectations, showing the results of a team effort that included families and healthcare researchers in the United States.

The team found that people do not make decisions alone. Instead, they rely on relationships and support systems around them. The model explains that there are four elements that must be understood to fully grasp how decisions unfold in healthcare: larger social influences such as insurance restrictions, the different people and roles involved, how these people relate during care, and the specific moment when a decision is made. These elements are crucial for understanding how decisions happen. Relationships among patients, their family supporters, and healthcare workers form the environment in which shared understanding becomes possible. In this environment, decisions are made. Shared understanding is needed for people to connect in meaningful ways and work together.

One especially meaningful aspect of this model is that it values the input of the patient—even when they cannot speak for themselves. In many cases, care partners, like family members, help interpret their loved one’s body language or reactions and share that understanding with the care team. This helps keep the patient’s needs and preferences central.

The model was developed through a combination of reviewing existing studies of care experiences, analyzing recordings of care sessions, and collecting input from those directly involved in care. Family members of individuals with conditions that affect awareness, such as brain injuries, worked closely with therapists to shape the model. It is called a “living model” because it is meant to grow and adapt as more experiences and research are added.

Rehabilitation researchers can now use this model to better understand care decisions. It respects the emotional and social aspects of healing and shows that every moment matters. By focusing on relationships and including all voices—especially those who may not be able to advocate for themselves—the Relationship-Centred Shared Decision-Making model offers a clearer and more compassionate way to guide healthcare choices.

Journal Reference

Papadimitriou C., Clayman M.L., Mallinson T., Weaver J.A., Guernon A., Meehan A.J., Kot T., Ford P., Ideishi R., Prather C., van der Wees P. “A New Process Model for Relationship-Centred Shared Decision-Making in Physical Medicine and Rehabilitation Settings.” Health Expectations, 2024. DOI: https://doi.org/10.1111/hex.14162