The role of the multidisciplinary team in balancing patients’ risk, autonomy, and self-determination during brain injury inpatient rehabilitation: a social worker’s perspective

Background: Rehabilitation is most likely to be effective when it aims to promote independence, autonomy and social engagement in line with the person’s wishes, to enhance their quality of life. Patients who experience acquired brain injury (ABI) receive multiple interventions to assist them in recovering from physical, cognitive, emotional, behavioural, and social impacts of their brain injury. Inpatient rehabilitation enables skilled professionals to provide an intensive and comprehensive treatment and intervention to help them regain their skills which in turn improves their function and quality of life. Despite the importance of these interventions, tensions can arise when making ethical decisions relating to risk taking and safety. This study seeks to explore the role and perspective of the social worker within the multidisciplinary team (MDT). There is a need to address the research gap in brain injury social work within rehabilitation settings, offering new insights into this field. Methods: A qualitative approach using semi structured interviews with 12 participants across three participant groups: patients, family/informal carers and professionals. Findings: Four themes were identified from the interview data using interpretive phenomenological analysis: 1) Promoting patients’ right to autonomy and selfdetermination, 2) Differing perspectives of patient, family and professionals on risk, 3) The legal and ethical considerations in decision making, 4) Discharge planning and resource constraints: Role of the social worker. Discussion: The research identified several key recommendations for policy and practice in addressing the needs of patients with ABI and their families including shared risk taking amongst the MDT, enhanced patient and family involvement, balance autonomy with tailored risk assessment, foster open communication and shared decision making, ABI training for social workers who undertake mental capacity assessments, standardised shared decision making framework, trauma informed practice and effective multidisciplinary team working.