I still remember this young veteran patient I worked with. Like many other patients I’d seen, he and his wife had been referred to me so that I could assess the current level of assistance he required for self care tasks and make appropriate recommendations in order to maximize his independence and reduce his reliance on his wife. As they explained his specific concerns and the areas where he required the most need, I excitedly started sharing information on adaptive equipment that could make so many of these tasks easier for both of them. The wife was delighted. I understood exactly what he needed help with and had given the perfect solutions for their home layout. But much to my surprise, the veteran looked at the adaptive equipment I was recommending and angrily asked if I was trying to make his house into a nursing home. In my excitement over the benefit of providing the veteran with increased independence and reducing the caregiver burden on the wife, I had overlooked the cost he would be paying–the cost of his dignity. He would rather have his wife privately assist with these self care tasks than have his needs publicly displayed by adaptive equipment visible to anyone who entered their home.

No intervention you choose to implement will be perfect. Rather, each will have its pros and its cons. So how do you determine which intervention to use? One great way is by completing a cost-benefit analysis of sorts for the intervention you plan to implement. Look at the benefits your client will gain from this intervention, whether they be increased independence, decreased fatigue, decreased reliance on caregivers, or any other range of benefits the interventions will provide. But then also look at the cost of those benefits, whether they are financial costs or more personal costs like loss of dignity. Then always finish by letting the final decision about whether to proceed with a specific intervention be up to the client or the person responsible for making their medical decisions.

Considering benefits
Identifying the benefits of an intervention are usually fairly simple. After all, you shouldn’t be implementing an intervention at all if there is no benefit to it. When talking to the client, be sure to explain these benefits clearly and in terms that they can easily understand. Make the benefits personal and directly applicable to the concerns they have identified to you. If the benefit you see is addressing something they may or may not understand the significance of (such as increasing their safety during a tub transfer), explain to them how increased safety means a decreased risk of falling and potential injury. You may even need to explain the potential consequences of a fall related injury so that they understand the seriousness of this prospect. Don’t overexaggerate the benefits, but don’t assume that your client will automatically see them, either.

Considering costs
Your client will likely have an easier time identifying the costs of an intervention than you will. So take a moment to step back and look at the situation from their perspective. How will implementing this intervention cause changes that the client may not view positively? Will this change their home? Will it change their appearance? Will it cost them financially beyond what they are willing to spend? Will it require a level of maintenance that they aren’t willing to take on? Think of anything non-positive that could be associated with a successful implementation of the intervention and be honest with your client about those costs. Also be open and willing to consider costs they identify that you might not have thought of.

Letting your client make the final choice
Ultimately, the decision about what intervention to implement depends on your client. Even if they say they trust you and want you to choose, they are the ones who will be responsible for the follow through and need to be fully invested in the decision in order to follow through appropriately and make the intervention a success. So please, please, make sure they are in agreement and invested in the chosen intervention. You will notice better outcomes and better client satisfaction when you do.

Weighing the costs and benefits for interventions ultimately requires us to view problems and identify solutions from the perspective of the client, rather than the provider. But viewing occupational therapy from this perspective can also make us more effective practitioners and better able to meet the needs of our clients. So next time, before you excitedly implement an intervention approach, stop and take a moment to identify what hidden cost your client might face and work as a team to weigh those costs against the perceived benefits.