Guided Self-Determination - What does "guided" mean in connection with self-determination?

OBJECTIVES: Persistent challenges in realizing empowerment for healthcare users prompted the development of an empowerment-based decision-making and problem-solving method, Guided Self-Determination (GSD). Its effectiveness and fidelity have been demonstrated across long-term conditions. However, discussion about the apparently paradoxical combination of "guided"and "self-determination"in the method's name call for a scientific discussion to provide clarity and resolve possible misunderstandings.

METHODS: Discussion conducted by researchers with expertise in translational empowerment, self-determination theory and the GSD method RESULTS: Self-determination theory (SDT) comprises many strong qualities, eg, empirical development and thorough conceptualization. However, like other theories, SDT appears to suffer from limitations related to practicality because its realization in clinical practice is not convincingly supported. The GSD method remedies these limitations through the use of reflection sheets, which users complete before discussions with healthcare professionals (HCPs), preparing them to take an active role. In GSD, HCPs do not 'guide' healthcare users to do as they recommend based on their general professional knowledge and expertise. Rather, GSD supports users in gaining self-insight through values clarification, thereby discovering their personal potential for change. Guided by reflection sheets, users and HCPs manage disagreement constructively and make shared decisions based on person-specific evidence about each user's challenges in daily life. A relational capacity for change is mobilized.

CONCLUSIONS: Guidance that respects and fosters autonomy can lead to true self-determination. Thus, guidance and self-determination are not contradictory; they are companions.

PRACTICE IMPLICATIONS: Decision-making and problem solving in clinical practice can better support users in becoming self-determined when guided by empowerment-based methods.