How an occupational science lens can be used to inform medical decisions: A case study.

Purpose: The purpose of this qualitative case study is to explore how and why clients with tetraplegia decide to pursue implantation of an upper limb neuroprosthetic application (device).  Methods: Recruitment partners invited persons to participate in the study if they they had a SCI resulting in tetraplegia, received an implanted neuroprosthesis from our clinic partner, completed the active phase of neuroprosthetic training, were 18 years of age or older, cognitively competent, English speaking, and a resident of the State of X. Two persons meeting the inclusion criteria participated in the study. Research question was what experiences and factors influenced participants to pursue implantation of a device. Data collection occurred during a two-month period for each participant. Using a semi-structured interview format, the PI conducted individual interviews asking them the research question. Co-investigators conducted a 2 to 4 hour observation of the participants at their location of choice as they participated in their daily routines. The participants were asked to take, choose, and describe 10 photographs that they felt best represented their lived experiences after receiving a device. All interviews were audiorecorded and transcribed verbatim. Data analysis followed the process used for case studies (Creswell & Poth, 2018). Trustworthiness was established through triangulation (multiple methods and investigators), an audit trail, constant checking of biases, and use of rich quotes. Findings: Daisy wanted to be able to do valued occupations to her liking, be able to do things with precision again, be able to do occupations that she enjoys, and reclaim her identity as a left handed and creative person and her role of daughter and advisor to others. Steve wanted to reclaim his identity as a physically fit person and athlete and roles as a father and pet-owner. Steve noted experiences of vulnerability also influenced his decision to obtain a device. Both wanted to feel more natural while doing valued occupations, and trust in the medical team was important to both. They also weighed the benefits and risks. Implications: Occupational participation, roles, and identity (Christiansen, 1999; Kielhofner, 2008) and the meaning of these to the person are important concepts to consider when a client is deciding whether to pursue surgical procedures such as implantation of neuroprosthetic applications. These concepts are not currently part of any shared decision-making models (Anderson et al., 2019; Heggland & Hausken, 2014).