Client-centred Care (Standard)

Standard of Practice: Client-centred Care

Bolded terms below are found in the Glossary.

Client Outcome

The client is meaningfully engaged in decision-making for their Massage Therapy care that centres the client’s unique needs, views, preferences and concerns and health goals.

Registered Massage Therapist Outcome

 The Registered Massage Therapist (RMT/MT) provides Massage Therapy that is focused on the best interests and unique needs, views, preferences and concerns of each individual client ensuring the client is actively involved in decision-making regarding their care.

Requirements

The RMT must:

1. Obtain the client’s informed consent (consent) prior to conducting an assessment, providing treatment or modifying a treatment plan. Consent must include a discussion with the client about the following six elements:
   1. the nature of the treatment;
   2. the expected benefits;
   3. risks and side effects;
   4. alternative courses of action;
   5. likely consequences of not having treatment; and
   6. the client’s right to ask questions about the information provided and that assessment or treatment will be stopped or modified at any time at their request.
2. Obtain the client’s written^[1] informed consent prior to every assessment and/or treatment of sensitive areas including the upper inner thighs, chest wall muscles, and the breasts. Breasts must not be touched except when assessment and/or treatment of the breast is requested by the client for a clinically indicated reason (for example, surgical intervention or perinatal care). Written informed consent must also be obtained prior to assessing and/or treating the buttocks (gluteal muscles), but can be obtained once per treatment plan (then verbally prior to every assessment and/or treatment).
3. Promote the client’s involvement in their own health goals by considering client input and supporting their informed decision-making in all aspects of client care.
4. Assess the client, including obtaining health history, to determine the client’s condition and if Massage Therapy is indicated, using the RMT’s knowledge, skills and professional judgement.
5. Develop a treatment plan for each client based on the assessment and client’s goals for treatment, monitor the client’s response and modify treatment accordingly.
6. Integrate an evidence-informed approach to care including using professional knowledge, experience and practice evaluation, external research, client perspective and practice context.
7. Only treat, or attempt to treat, conditions within the RMT’s competence and the Scope of Practice of Massage Therapy.
8. If they have dual registration, ensure the client understands when and in what circumstances care is being provided within the Scope of Practice of Massage Therapy, and when care is being provided within the scope of another health profession in which the RMT is regulated.
9. When appropriate and with the client’s consent, refer the client to another RMT, healthcare professional or person whose expertise can best address the client’s needs.
10. Provide fair and equitable access and consistent quality of care to all clients.
11. Treat all clients with respect and dignity.
12. Ensure the client’s continuing comfort and safety during the treatment, addressing any intended and unintended effects and outcomes as required.
13. Drape in accordance with the Standard of Practice: Draping and Physical Privacy.
14. Work with the client and others, as required, to plan and implement discharge from care.
15. Only discontinue providing care to a client if the discharge process has been documented in the client’s file and:
    1. treatment is no longer needed; or
    2. the client requests the discontinuation; or
    3. alternative services are arranged; or
    4. the client is abusive or is a real or perceived threat to the RMT and the RMT has made all reasonable attempts to arrange alternative services; or
    5. the client is given reasonable opportunity to arrange alternative services.
16. Never abuse a client; this includes, but is not limited to, verbal, physical, psychological, emotional, sexual or financial abuse.
17. Never have a sexual relationship with a client. This is sexual abuse. As it pertains to sexual abuse, a client will meet the definition of “client” for one year after they ceased to be the RMT’s client. That is, an RMT may not enter into a sexual relationship with a client for a period of one year after the client ceased to be a Massage Therapy client. Additionally, it might never be ethically appropriate to have a sexual relationship with a person who was previously a client, regardless of the passage of time, due to power dynamics, the disclosing of health information or other reasons. Even if this might not constitute “sexual abuse” within the definition in the legislation, it could still be professional misconduct.
18. At the client’s request, securely transfer copies of the client’s health record to another RMT or other healthcare professional.
19. Upon resignation, or closure of a clinic, refer the client to another RMT, healthcare professional or person whose expertise can best address the client’s needs; and take necessary actions to ensure client health records are properly retained, transferred and disposed of.

Relevant Legislation and Regulation

• Regulated Health Professions Act, 1991 (RHPA)
• Health Care Consent Act, 1996 (HCCA)
• Professional misconduct in Section 26 of Ontario Regulation 544/94 under the Massage Therapy Act, 1991

Related Career-Span Competencies (CSCs)