Shared Decision-Making in Action
To move from theory to practice, we must bridge the gap between shared decision-making and self-directed training. Shared decision-making isn't just a conversation; it is the engine that drives patient ownership. By shifting how we communicate, we empower patients to manage their own recovery during the "inactivity gaps" of the hospital day.
Identifying Key Barriers to
Collaborative Communication
Recognizing the internal and systemic hurdles to partnership is the first step toward developing the clinical skills to overcome them. These barriers often include:
The SHARE Protocol
To navigate these hurdles and advance your clinical skillset, we utilize the SHARE Approach. This five-step process provides a structured framework for the bedside, ensuring that shared decision-making is integrated into every interaction.
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For a deeper dive into these techniques, you can click here for the AHRQ SHARE Approach Training Workshops to see how these conversations flow in complex clinical settings.
(Agency for Healthcare Research and Quality [AHRQ], 2014; AHRQ Patient Safety, 2024)
1
Seek Your Patient's Participation
Invite the survivor to join the team and take an active role in deciding their next steps.
​Click to watch Step 1 of the AHRQ SHARE Approach Training video
2
Help Compare Options
Present clear evidence-based choices so the survivor can weigh the benefits and drawbacks of different activities.
Click to watch Step 2 of the AHRQ SHARE Approach Training video
3
Assess Your Patient's Values & Preferences
Ask the vital question: "Does this fit your life?" to ensure the training plan aligns with their personal goals and home environment.
Click to watch Step 3 of the AHRQ SHARE Approach Training video
4
Reach a Decision with Your Patient
Focus on reaching a mutual agreement on the next steps rather than simply prescribing a set of exercises.​
Click to watch Step 4 of the AHRQ SHARE Approach Training video
5
Evaluate Your Patient's Decision
Continuously track progress and adjust the plan together based on the survivor’s real-world experience.
Click to watch Step 5 of the AHRQ SHARE Approach Training video
Moving towards
Collaborative Language
Transitioning from leading the patient towards partnering with them is the essential link to successful self-directed training. While typical instructional tendencies often involve taking the lead, shifting your language builds the autonomy patients need to own their recovery (Armstrong, 2017; Wulf & Lewthwaite, 2016). By intentionally evolving how you communicate, you turn every session into an opportunity for the patient to practice self-correction and independent problem-solving.​
Explore the scenarios below:
For computer users: Hover your cursor over each box below to see how typical instructional cues can be shifted towards a collaborative partnership.
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For mobile phone users: Click each button below to see how typical instructional cues can be shifted towards a collaborative partnership.
Clinician-As-Partner
Clinician-as-Expert
"I've blocked out 2:00 PM for your independent practice in the gym today."
"Would you prefer to head to the gym for your extra practice at 2:00 PM, or would you rather work on those goals here in your room?"
The Why
Autonomy Support: Shifting from imposing a schedule to offering options fosters ownership and intrinsic drive.
Clinician-as-Partner
Clinician-as-Expert
"Your arm is still very weak, so we have to keep practicing these movements."
"You’ve shown great progress in your control today. Now, let's focus on reaching for the brush so you can get ready for the day."
The Why
Enhanced Expectancies: Shifting focus from impairment to progress and identity builds self-efficacy and task-value.
Clinician-as-Partner
Clinician-as-Expert
"I need you to straighten your elbow while you reach for that cup."
"Try to focus on reaching all the way to the handle of the cup. Which of these objects would you like to practice with first?"
The Why
External Focus: Using task-oriented cues (the handle) instead of body-part cues (the elbow) improves motor learning efficiency.
Let's put it into practice
While a single word choice might seem small, the cumulative effect is what shifts the dynamic in a clinical session.
Use the comparison below to see how these cues look in a real-world "Friday Planning" conversation.
Instructions:
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Review Script A: Click through the slides to see a typical clinician-as-expert approach.​Review Script B: See how the conversation changes when the clinician acts as a collaborative partner.​The Goal: Notice the difference in how the survivor responds to each style.
Script A:
The Clinician-as-Expert Approach
The Context: A clinician and survivor are discussing "extra practice" for the upcoming weekend. The goal is to establish a plan for independent activity without the therapist present.
"Alright, before I head out for the weekend, I’ve written down your home exercise program. I want you to do 10 repetitions of the "standing at the sink" reach, twice a day on Saturday and Sunday.
It’s really important that you get these reps in so we don't lose the progress we made this week. Can you commit to doing that for me?"
Clinician A
Script B:
Partnering with the Stroke Survivor
The Context: A clinician and survivor are discussing "extra practice" for the upcoming weekend. The goal is to establish a plan for independent activity without the therapist present.
"Since you mentioned that being able to make your own coffee in the morning is a big goal for you, I’d like to plan some extra practice for the weekend that moves us closer to that.
Which part of your morning routine feels like the most meaningful thing for you to try on your own... standing at the counter to prep, or practicing the reach for your favorite mug?"
Clinician B
In Summary...
Shifting to a collaborative partnership is the functional link that makes self-directed training possible. By moving away from a clinician-led approach, you help the survivor transition from passive compliance toward active ownership of their recovery. This module focused on three core skills: Identifying barriers to shared decision-making, refining feedback to support a more collaborative role, and adopting a shared approach to co-author a meaningful plan. When survivors help decide the "what" and the "how" of their practice, they are no longer just following instructions. They are building the ownership needed to initiate self-directed practice on their own throughout the day.
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Ready for the Next Step?
The final phase of the From Expert to Collaborator section focuses on personal practice refinement.
The Professional Habit Reflection provides a structured space to identify specific clinician-led tendencies and prescriptive habits that may hinder a collaborative approach.