Shared decision-making is a core principle of contemporary occupational therapy practice. It recognises that high-quality clinical decisions occur when professional expertise and lived experience are combined.

Within assistance animal practice, shared decision-making is particularly important because recommendations affect:

• the person’s daily life;
• their occupational participation;
• their family and support networks;
• the animal’s welfare and future;
• the long-term sustainability of the partnership.

An assistance animal is not simply prescribed to a person.

A partnership is developed between a person and another living being.

Therefore, goal setting must involve collaboration between:

• the person seeking support;
• occupational therapist;
• assistance animal professionals;
• relevant family members or supporters where appropriate;
• the animal’s welfare considerations.

The Person as an Expert in Their Own Life

People living with disability are experts in their own experiences.

They bring essential knowledge about:

• what matters to them;
• what barriers they experience;
• what strategies have worked previously;
• what outcomes they value;
• what they hope to achieve.

This lived experience is essential when developing meaningful goals.

For example:

A person may identify that their primary goal is not simply:

“Having a dog.”

Their actual goal may be:

• attending university;
• returning to work;
• parenting more independently;
• accessing healthcare;
• participating in community activities;
• feeling confident leaving the home.

The occupational therapist’s role is to explore the occupational meaning behind the request.

Professional Expertise Remains Essential

Shared decision-making does not mean that every requested intervention should automatically proceed.

The occupational therapist contributes professional expertise regarding:

• occupational performance;
• functional assessment;
• intervention options;
• evidence;
• risks and benefits.

The OT may identify considerations that the person has not previously considered, such as:

• whether an assistance animal is the most appropriate intervention;
• whether another support may achieve the goal more effectively;
• whether expectations are realistic;
• whether the household can sustain the partnership.

Professional reasoning protects both the person and the animal.

Moving From “What the Person Wants” to “What the Person Needs”

A person’s initial request is important information, but assessment must explore the underlying need.

For example:

Request:

“I want an assistance dog because I cannot manage anxiety.”

The occupational therapist explores:

• What situations are affected?
• What occupations are limited?
• What does the person want to do differently?
• What strategies are currently used?
• What role could an assistance animal realistically play?

The goal may become:

“Increase participation in community activities by reducing barriers associated with disability-related anxiety.”

The assistance animal becomes one possible intervention pathway.

Avoiding Professional Paternalism

Historically, healthcare systems have sometimes made decisions about people with disability without sufficient involvement of the person themselves.

This approach can result in:

• reduced autonomy;
• assumptions about capability;
• interventions that do not align with personal priorities.

Shared decision-making challenges this by recognising that people should be active participants in decisions affecting their lives.

The occupational therapist should avoid:

• assuming what outcomes matter;
• deciding goals without collaboration;
• focusing only on impairment;
• ignoring lived experience.

Avoiding Consumer-Led Intervention Without Assessment

The opposite risk is assuming that person-centred practice means the professional simply provides whatever is requested.

This may occur when:

• a person has researched assistance animals online;
• a social media community has suggested specific tasks;
• another person has had a positive experience;
• an organisation has suggested a particular pathway.

The occupational therapist must respectfully explore whether the requested intervention is clinically appropriate.A person may request an assistance animal because they need support.

The role of assessment is to determine whether an assistance animal is the right support.

Shared Decision-Making and Goal Prioritisation

Many people experience multiple occupational challenges.

However, not every challenge needs to become an assistance animal goal.

Goal prioritisation involves considering:

• what matters most to the person;
• what has the greatest impact on participation;
• what is realistic;
• what can appropriately be supported by an animal.

For example:

A person may identify:

• difficulty sleeping;
• difficulty shopping;
• difficulty travelling;
• difficulty maintaining routines.

The occupational therapist explores which goals:

• are meaningful;
• relate to disability-related barriers;
• could realistically involve an assistance animal.

Including Family and Support Networks Appropriately

For children and people requiring significant support, shared decision-making may involve family members or carers.

However, the person’s own voice should remain central wherever possible.

Considerations include:

• the person’s preferences;
• communication needs;
• decision-making supports;
• caregiver capacity;
• family expectations.

Family members may provide important information about:

• routines;
• safety;
• practical support.

However, the assistance animal partnership should not become solely focused on reducing caregiver burden.

The primary purpose remains supporting the individual’s occupational participation.

Shared Decision-Making and Children

When assistance animals are considered for children, goal setting requires careful consideration.

Important questions include:

• What does the child want?
• What occupations are meaningful to the child?
• How will the child participate in the partnership?
• What responsibilities are developmentally appropriate?
• How will adults support the partnership?

A child should not receive an assistance animal simply because adults believe it may be helpful.

The child’s experience, preferences and wellbeing must be considered.

Considering the Animal as a Partner in Decision-Making

Although animals cannot participate in human decision-making, their welfare must be represented within the process.

The partnership must consider:

• whether the role suits the animal;
• whether expectations are reasonable;
• whether workload is appropriate;
• whether the animal has opportunities for rest and normal behaviour.

Ethical assistance animal practice recognises that the animal is not merely a tool.

The animal is a working partner with its own welfare needs.

Shared Decision-Making Across the Partnership Lifespan

Goals should not be established once and then ignored.

Life changes may affect:

• occupational priorities;
• disability needs;
• environmental circumstances;
• animal capacity.

Shared decision-making continues throughout the partnership.

Review questions include:

• Is the partnership still supporting the person’s goals?
• Have goals changed?
• Are tasks still meaningful?
• Is the animal still coping well?
• Are adjustments needed?

Examples of Shared Decision-Making

Example 1: Adult Handler

Person’s goal:

“I want to return to work.”

OT explores:

• job demands;
• barriers;
• environmental factors;
• whether assistance animal support is appropriate.

Together, they identify realistic outcomes.

Example 2: Child Handler

Parent’s goal:

“We want a dog because our child struggles.”

OT explores:

• child’s goals;
• family environment;
• developmental needs;
• whether other supports are required.

The decision is made collaboratively.

Example 3: Older Adult

Person’s goal:

“I want to remain independent.”

OT explores:

• current abilities;
• environmental barriers;
• animal care capacity;
• whether the partnership can remain sustainable.

Implications for Occupational Therapy Practice

Occupational therapists should:

• actively involve the person in goal development;
• value lived experience;
• provide balanced information;
• explain risks and alternatives;
• support informed choices;
• advocate for appropriate interventions;
• consider animal welfare.

Shared decision-making ensures assistance animal recommendations are neither imposed upon people nor provided without appropriate assessment.

Key Practice Principles

1. Shared Decision-Making Combines Expertise

The person and professional each contribute essential knowledge.

2. The Person’s Goals Drive Intervention

Assistance animals should support what matters to the person.

3. Person-Centred Practice Requires Professional Reasoning

Respecting choice does not remove clinical responsibility.

4. Requests Require Exploration

The initial request provides information but does not replace assessment.

5. Families and Support Networks Should Be Included Appropriately

They provide valuable information while maintaining the person’s central role.

6. The Animal’s Welfare Must Be Represented

A successful partnership considers both human and animal needs.

7. Goals Should Evolve Over Time

Assistance animal partnerships require ongoing review and collaboration.

Shared decision-making ensures assistance animal practice remains grounded in respect, autonomy and professional responsibility. By combining the person’s lived experience with occupational therapy expertise and consideration of animal welfare, practitioners can support recommendations that are meaningful, ethical and sustainable.