Shared Decision Making in Mental Health Treatment: Qualitative Findings From Stakeholder Focus Groups (original) (raw)
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Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry
Journal of Community Mental Health, 2021
There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.
Shared Decision Making and Serious Mental Illness
This study examined medication decision making by 84 persons with serious mental illness, specifically examining relationships among perceived coercion, decisional capacity, preferences for involvement and actual participation, and the outcomes of medication adherence and QoL. Multiple and logistic regression analysis were used in this cross-sectional, descriptive study, controlling for demographic, socio-economic and utilization variables. Appreciation was positively related to medication adherence behaviors for the past six months. Females, older individuals and those living independently were more likely to have taken all their medications over the past six months. Neither client participation, preference, nor preference-participation agreement was found to be associated with better medication adherence or QoL.
Time to Support Extensive Implementation of Shared Decision Making in Psychiatry
JAMA Psychiatry, 2021
Shared decision making (SDM) is a health communication approach focusing on patient-clinician interactions around treatment decisions, with the goals of improving clinical and functional outcomes and providing personalized care. 1 The fundamental principles of SDM involve (1) eliminating power asymmetries between clinician and patient; (2) acknowledging that there are at least 2 expert participants: a patient having livedexperience expertise, a clinician having professional expertise, and sometimes a family member 2 ; (3) eliciting patient preferences for their involvement in the decisionmaking (autonomously, conjointly with clinician input, letting clinician make decisions) and eliciting the patient's specific values that could guide the decision (eg, reducing medication adverse effects); (4) discussing at least 2 treatment options (eg, taking, tapering, or stopping antipsychotic medications); (5) making a decision that aligns with the patient's goals, preferences, and values that also makes clear the risks involved in particular decisions 3 ; and (6) accepting that the patient's choice of treatment plan may differ from the clinician's recommendation. SDM has been endorsed as the gold standard of patient-clinician interaction in preferencebased care by the National Academy of Medicine in the US and the National Institute for Health and Care Excellence in the UK. Studies in the last decade of individuals with serious mental illness (SMI) demonstrating the feasibility of using SDM, and showing the potential for improved outcomes, support the recent acknowledgment of SDM as an essential practice by the American Psychiatric Association 4 and the Substance Abuse and Mental Health Services Administration.
Frontiers in Psychiatry, 2021
Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a d...
Health communication, 2018
Shared decision making (SDM) is an effective health communication model designed to facilitate patient engagement in treatment decision making. In mental health, SDM has been applied and evaluated for medications decision making but less for its contribution to personal recovery and rehabilitation in psychiatric settings. The purpose of this pilot study was to assess the effect of SDM in choosing community psychiatric rehabilitation services before discharge from psychiatric hospitalization. A pre-post non-randomized design with two consecutive inpatient cohorts, SDM intervention (N = 51) and standard care (N = 50), was applied in two psychiatric hospitals in Israel. Participants in the intervention cohort reported greater engagement and knowledge after choosing rehabilitation services and greater services use at 6-to-12-month follow-up than those receiving standard care. No difference was found for rehospitalization rate. Two significant interaction effects indicated greater improv...
Pushing the envelope: Shared decision making in mental health
Psychiatric Rehabilitation Journal, 2010
Topic: This article reviews the literature on shared decision making in health and mental health and discusses tools in general health that are proposed for adaptation and use in mental health. Purpose: To offer findings from literature and a product development process to help inform/guide those who wish to create or implement materials for shared decision making in mental health. Sources used: Published literature and research on issues related to shared decision making in health and mental health, focus groups, and product testing. Conclusions: Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue.
Shared decision-making in serious mental illness: A comparative study
Patient Education and Counseling, 2020
To compare consumer and mental health professionals' (MHPs) preferences for decisionmaking in China and Europe. Methods: This study used cross-sectional design; Chinese data were collected by questionnaires and European data were obtained from the literature. Data were analysed using t-test, One-way ANOVA and Pearson correlation coefficient as appropriate. Results: This study involved 800 people diagnosed with severe mental illness and 506 MHPs. Chinese participants rated lower scores on preference for participation in decision-making (PD = 1.88) and information (IN = 2.70) than European participants (PD = 2.05, IN = 2.83). Chinese consumers rated a higher score on IN (2.78) but lower on for PD (1.75) than MHPs (IN = 2.64, PD = 1.97). Chinese consumers' education level is positively associated with preference for PD and IN. The gender, occupation and age of Chinese MHPs are associated with preference for PD. Conclusion: Both Chinese and Europeans had preference for shared involvement in mental health, while the preference in China is less. Opinions of consumers and MHPs might be different, regarding the level of patient involvement in specific decisions. Practice implication: It is essential that consumers' preferences are understood for provision of optimal support for a shared decision-making approach.
Medication decision-making by persons with serious mental illness
Archives of Psychiatric Nursing, 2004
This study examined medication decision making by 84 persons with serious mental illness, specifically examining relationships among perceived coercion, decisional capacity, preferences for involvement and actual participation, and the outcomes of medication adherence and QoL. Multiple and logistic regression analysis were used in this cross-sectional, descriptive study, controlling for demographic, socio-economic and utilization variables. Appreciation was positively related to medication adherence behaviors for the past six months. Females, older individuals and those living independently were more likely to have taken all their medications over the past six months. Neither client participation, preference, nor preference-participation agreement was found to be associated with better medication adherence or QoL.