Background: Driving is important for clients ́ wellbeing, independence and participation and driving evaluations often involve occupational therapists. The evaluation is complex and established procedures and descriptions of the decision-making process are missing. Aims: To describe the experiences and clinical reasoning of occupational therapists in driving evaluations including on-road test in real traffic. Material and Methods: Qualitative study based on interviews with eight occupational therapists where the simultaneous data collection and analysis followed a constant comparative method with a grounded theory approach. Results: Reasoning of the occupational therapists reflect a consistent strive to understand the clients ́ ability and needs related to safe driving, described by one main category: Striving to include all aspects into the driving evaluation and three subcategories; Understanding driving behaviour, ́Weighting different aspects in relation to risk and Creating and giving fair comprehensible feedback. Conclusions: Occupational therapists meet many challenges in making correct driving evaluations and dealing with clients ́ frustration and need of continued participation. Complexity and a constant shift between client and professional perspective characterize their reasoning. Further education and collegial network exchange is required to ensure quality in client relations, evaluations and interventions related to driving.