Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making

Foster, Michele, Tilse, Cheryl and Fleming, Jennifer (2004) Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making. Social Science & Medicine, 59 9: 1867-1878. doi:10.1016/j.socscimed.2004.02.017

Author Foster, Michele
Tilse, Cheryl
Fleming, Jennifer
Title Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making
Journal name Social Science & Medicine   Check publisher's open access policy
ISSN 0277-9536
Publication date 2004-11
Sub-type Article (original research)
DOI 10.1016/j.socscimed.2004.02.017
Volume 59
Issue 9
Start page 1867
End page 1878
Total pages 12
Editor S. Macintyre
Place of publication United Kingdom
Publisher Elsevier/Pergamon
Collection year 2004
Language eng
Subject C1
370201 Clinical Social Work Practice
730200 Public Health
Abstract The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral. (C) 2004 Elsevier Ltd. All rights reserved.
Keyword Traumatic Brain Injury
Professional Decicion-making
Public, Environmental & Occupational Health
Social Sciences, Biomedical
Professional Decision-making
Severe Head-injury
Practical Issues
Q-Index Code C1

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Citation counts: TR Web of Science Citation Count  Cited 10 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 12 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 04:48:11 EST