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How a patient decides to receive BT injections after becoming aware of the treatment remains unclear. In this exploratory qualitative study, we aimed to investigate patients\u2019 decision-making about treatment strategies in collaboration with family and health professionals and to identify conflicts in patients\u2019 feelings about BT treatment.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The study included six patients with stroke sequelae. Data were collected using comprehensive interviews and were analyzed using the grounded theory approach and trajectory equifinality modeling.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>After patients learned about BT treatment, they clearly exhibited the following two concurrent perceptions: \u201cthe restriction of one\u2019s life due to disabilities\u201d and \u201cthe ability to do certain things despite one\u2019s disabilities.\u201d Some patients reported a \u201cfear of not being able to maintain the status quo owing to the side effects of BT.\u201d To alleviate this fear, timely support from family members was offered, and patients overcame anxiety through creative thinking. However, there were also expressions that revealed patients\u2019 difficulties dealing with negative events. These factors influenced the patients\u2019 development of \u201cexpectations of BT\u201d or \u201chesitations about BT.\u201d<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>To establish treatment strategies in collaboration with patients, healthcare professionals should show supportive attitudes and have discussions with patients and their family members to help patients resolve their conflicts and should establish treatment strategies that maintain the positive aspects of patients\u2019 lives.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12911-019-1003-9","type":"journal-article","created":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T18:03:25Z","timestamp":1576778605000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Selection process for botulinum toxin injections in patients with chronic-stage hemiplegic stroke: a qualitative study"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2351-2239","authenticated-orcid":false,"given":"Sawako","family":"Arai","sequence":"first","affiliation":[]},{"given":"Yuko","family":"Fukase","sequence":"additional","affiliation":[]},{"given":"Akira","family":"Okii","sequence":"additional","affiliation":[]},{"given":"Yoshimi","family":"Suzukamo","sequence":"additional","affiliation":[]},{"given":"Toshimitsu","family":"Suga","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2019,12,19]]},"reference":[{"key":"1003_CR1","first-page":"29","volume":"2","author":"G Bavikatte","year":"2009","unstructured":"Bavikatte G, Gaber T. 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All patients signed an informed consent form before participating in the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The participants agreed to the use of their anonymized personal information for the research.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"TS received grant support from Merz Pharmaceuticals GmbH and Glaxo Smith Kline K.K. All other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"280"}}