The clinical reasoning of occupational therapists in an oncology setting: An exploration of documentation following MOHO training

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Individuals with or recovering from cancer experience a range of physical and mental changes due to the diagnosis and its treatments. Occupational therapy practitioners often participate as part of the comprehensive rehabilitation team in oncology treatment settings, providing interventions meant to encourage participation and performance in meaningful life activities, regardless of life expectancy. Clinical reasoning is the process by which occupational therapy practitioners make decisions related to the intervention process. Use of an occupation-based model, such as the Model of Human Occupation (MOHO) (Taylor & Kielhofner, 2017), to guide clinical reasoning may lead to more occupation-focused interventions, and increased evidence of the distinct value of occupational therapy services for individuals with and recovering from cancer. The purpose of this study was to explore both the occupational therapy clinical documentation and the clinical reasoning of occupational therapists within an oncology setting after post-professional training in the MOHO using a qualitative case study design. Multiple sources of data, including retrospective occupational therapy documentation from the electronic medical record of patients and participant feedback (interview/focus group), were obtained to answer the overarching research question: What effect does participation in MOHO training have upon the clinical documentation in the practice of occupational therapists working within an oncology setting? Clinical documentation was analyzed using both an inductive approach and a deductive approach over three time periods: 1) prior to the MOHO training, 2) three-months after the training, and 3) six months after the training. An inductive approach to thematic analysis was completed with both the supervisor interview and the focus group. Results of the documentation analysis revealed three major purposes of documentation in the oncology setting. An increase in occupation-focused language in occupational therapy documentation was noted from prior to the MOHO training to six months after the MOHO training. The two major themes uncovered during data analysis of the supervisor interview were: 1) Rejuvenated Practice and 2) Efficiency in the EMR. The two overarching themes that emerged from the Focus Group were: 1) Uniqueness in the Occupational Profile and 2) Resurgence of the Occupation in Occupational Therapy.

Model of Human Occupation, Clinical Reasoning