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Hormazábal-Salgado R, Whitehead D, Osman AD, Hills D. Person-Centred Decision-Making in Mental Health: A Scoping Review. Issues Ment Health Nurs 2024; 45:294-310. [PMID: 38232185 DOI: 10.1080/01612840.2023.2288181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Person-centred decision-making approaches in mental health care are crucial to safeguard the autonomy of the person. The use of these approaches, however, has not been fully explored beyond the clinical and policy aspects of shared and supported decision-making. The main goal is to identify and collate studies that have made an essential contribution to the understanding of shared, supported, and other decision-making approaches related to adult mental health care, and how person-centred decision-making approaches could be applied in clinical practice. A scoping review of peer-reviewed primary research was undertaken. A preliminary search and a main search were undertaken. For the main search, eight databases were explored in two rounds, between October and November 2022, and in September 2023, limited to primary research in English, Spanish or Portuguese published from October 2012 to August 2023. From a total of 12,285 studies retrieved, 21 studies were included. These research articles, which had mixed quality ratings, focused on therapeutic relationships and communication in decision-making (30%), patients' involvement in treatment decision-making (40%), and interventions for improving patients' decision-making engagement (30%). While there is promising evidence for shared decision-making in mental health care, it is important that healthcare providers use their communicational skills to enhance the therapeutic relationship and engage patients in the process. More high-quality research on supported decision-making strategies and their implementation in mental health services is also required.
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Affiliation(s)
- Raúl Hormazábal-Salgado
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Dean Whitehead
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Abdi D Osman
- College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Danny Hills
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
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Verwijmeren D, Grootens KP. Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care. Community Ment Health J 2024; 60:292-307. [PMID: 37550559 PMCID: PMC10821819 DOI: 10.1007/s10597-023-01170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.
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Affiliation(s)
- Doris Verwijmeren
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands.
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Haugom EW, Benth JŠ, Stensrud B, Ruud T, Clausen T, Landheim AS. Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study. BMC Psychiatry 2023; 23:747. [PMID: 37833737 PMCID: PMC10576360 DOI: 10.1186/s12888-023-05257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making. METHODS This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores. RESULTS The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001). CONCLUSIONS The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided. TRIAL REGISTRATION NCT03271242, date of registration: 5 Sept. 2017.
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Affiliation(s)
- Espen W Haugom
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway.
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway
| | - Bjørn Stensrud
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Anne Signe Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Pérez-Revuelta JI, González-Sáiz F, Pascual-Paño JM, Mongil-San Juan JM, Rodríguez-Gómez C, Muñoz-Manchado LI, Mestre-Morales J, Berrocoso E, Villagrán Moreno JM. Shared decision making with schizophrenic patients: a randomized controlled clinical trial with booster sessions (DECIDE Study). PATIENT EDUCATION AND COUNSELING 2023; 110:107656. [PMID: 36807126 DOI: 10.1016/j.pec.2023.107656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The treatment of schizophrenia requires a prolonged, multidimensional intervention that includes antipsychotic drugs. Treatment adherence is essential to effectively control the disorder. Shared decision-making (SDM) is a strategy, supported by numerous practical and ethical arguments, that seeks to involve patients in the therapeutic process to improve treatment adherence and satisfaction. The use of this model in mental health has been limited for many intrinsic and extrinsic reasons. The results of clinical trials conducted to date have largely been disappointing, potential due to study design-related limitations. AIM/QUESTION To evaluate the efficacy, in terms of treatment adherence and improvement in clinical variables, such as severity of symptoms, days of hospitalization or insight, of a carefully timed SDM model initiated immediately prior to hospital discharge in patients with schizophrenia. METHODS Single-blind, randomized clinical trial in an acute psychiatric care unit within the Andalusian Health Department to compare SDM (experimental group) to treatment as usual (TAU; control group) in a sample of patients hospitalized for an acute episode of schizophrenia or schizoaffective disorder. The study was performed between January 2014 and June 2017. The experimental group participated in SDM sessions prior to discharge with regular booster sessions over the one-year follow-up. The health care team responsible for SDM was predisposed to concordance (LatCon II scale) and received specific training in SDM. A hierarchical multiple linear regression analysis was performed to evaluate the factors independently associated with adherence, controlling for sociodemographic, clinical, and admission-related variables. Variables were assessed at admission, discharge and at 3, 6 and 12 months after discharge during the one year follow up. BARS, DAI, WAI-S, COMRADE and PANSS were used to evaluate adherence, attitude to treatment, therapeutic alliance, satisfaction and confidence with decision and clinical status, respectively. RESULTS A total of 227 schizophrenic patients hospitalized with acute decompensation were evaluated; of these, 102 met all inclusion criteria and were included in the study. Most patients (95%) had prior experience with antipsychotics and most (82%) had experienced related side effects. Despite randomization, psychopathologic severity was greater in the experimental group, with a mean (SD) PANSS score of 104.08 (80) vs. 93.45 (20.30) (p < 0.05). The final regression model to explain adherence was significant (adjusted R2 = 0.384; F [df= 6] = 4.386; p < 0.001), with a direct, significant and independent association with SDM mediated by the number of booster sessions. DISCUSSION Shared decision making with booster sessions appears to increase treatment adherence in patients with severe mental disorders. IMPLICATION ON PRACTICE Ethical, practical, and clinical reasons support the use of strategies designed promote the use of long-term, shared decision-making in psychiatric patients, especially in schizophrenia spectrum disorder.
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Affiliation(s)
- Jose I Pérez-Revuelta
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
| | - Francisco González-Sáiz
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
| | - Juan M Pascual-Paño
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Jose M Mongil-San Juan
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Carmen Rodríguez-Gómez
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Leticia I Muñoz-Manchado
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
| | - Jesús Mestre-Morales
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain.
| | - Esther Berrocoso
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Neuropsychopharmacology and Psychobiology Research Group, Department of Psychology, University of Cádiz, Cádiz, Spain.
| | - Jose Ma Villagrán Moreno
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
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Patient-provider communication while using a clinical decision support tool: explaining satisfaction with shared decision making for mammography screening. BMC Med Inform Decis Mak 2022; 22:323. [PMID: 36476612 PMCID: PMC9730626 DOI: 10.1186/s12911-022-02058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Clinical decision aids may support shared decision-making for screening mammography. To inform shared decision-making between patients and their providers, this study examines how patterns of using an EHR-integrated decision aid and accompanying verbal patient-provider communication predict decision-making satisfaction. METHODS For 51 patient visits during which a mammography decision aid was used, linguistic characteristics of patient-provider verbal communication were extracted from transcribed audio recordings and system logs automatically captured uses of the decision aid. Surveys assessed patients' post-visit decisional satisfaction and its subcomponents. Linear mixed effects models assessed how patients' satisfaction with decision making was related to patterns of verbal communication and navigation of the decision aid. RESULTS The results indicate that providers' use of quantitative language during the encounter was positively associated with patients' overall satisfaction, feeling informed, and values clarity. Patients' question-asking was negatively associated with overall satisfaction, values clarity, and certainty perception. Where system use data indicated the dyad had cycled through the decision-making process more than once ("looping" back through pages of the decision aid), patients reported improved satisfaction with shared decision making and all subcomponents. Overall satisfaction, perceived support, certainty, and perceived effectiveness of decision-making were lowest when a high number of navigating clicks occurred absent "looping." CONCLUSIONS Linguistic features of patient-provider communication and system use data of a decision aid predict patients' satisfaction with shared decision making. Our findings have implications for the design of decision aid tools and clinician training to support more effective shared decision-making for screening mammography.
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Harding S. Supported Decision Making: Skills and Tools for Clinical Practice. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Cheung EH, Petersen E, Zhang L, Wilkerson C, Barceló NE, Soderlund PD, Yerstein M, Wells K. Drivers of shared decision making in inpatient psychiatry: An exploratory survey of patients' and multi-disciplinary team members' perspectives. Gen Hosp Psychiatry 2022; 79:7-14. [PMID: 36152457 DOI: 10.1016/j.genhosppsych.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence and predictors of Shared Decision Making (SDM) in an adult, inpatient psychiatric setting. METHOD Multi-disciplinary clinician focus groups and patient pre-testing informed the development of a survey on 4 SDM and 11 factors hypothesized to interfere with SDM. The survey was administered to 89 adult inpatients (80% response rate) and their treatment team psychiatrists, nurses, and social workers (n = 338 ratings, 95% response rate). Group differences and predictors were estimated using t and F-tests. RESULTS Patients' mean SDM score (n = 64, standardized Cronbach alpha = 0.858) was 3.35 ± 1.13 (5 = highest agreement), and correlated with overall satisfaction with care (n = 61, r = 0.399, p = 0.001). Patients' disagreement with clinician's diagnosis (44% of patients) correlated with lower SDM ratings by patients (t = 2.55, df = 62, p = 0.013) and by clinicians (t = 2.99, df = 69, p = 0.004). Psychotic diagnoses were not a significant determining factor for SDM. Overall, clinicians rated SDM more favorably than patients (t = -5.43, df = 63, p < 0.001), with nurses and social workers rating SDM higher than physicians (p < 0.001). CONCLUSIONS Diagnostic agreement / disagreement is a key predictor of SDM for patients and clinicians, while presence of psychosis is not. SDM was rated higher by clinicians than patients. SDM ratings vary significantly between clinical disciplines.
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Affiliation(s)
- Erick H Cheung
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Emily Petersen
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America
| | - Lily Zhang
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America
| | - Catherine Wilkerson
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America
| | - Nicolás E Barceló
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America; Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America
| | - Patricia D Soderlund
- National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America; Memory Keepers Medical Discovery Team - Health Equity, University of Minnesota Medical School, Duluth Campus, 624 East 1st St, #201, Duluth, MN 55805, United States of America
| | - Maria Yerstein
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, United States of America
| | - Kenneth Wells
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America; Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America; Department of Mental Health, Veterans Affairs Greater Los Angeles HealthCare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073-1003, United States of America
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Boerkoel A, Brommels M. The processes involved in the establishment of user-provider partnerships in severe psychiatric illnesses: a scoping review. BMC Psychiatry 2022; 22:660. [PMID: 36289473 PMCID: PMC9608879 DOI: 10.1186/s12888-022-04303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE With the rising relevance of person-centred care, initiatives towards user-led decision making and designing of care services have become more frequent. This designing of care services can be done in partnership, but it is unclear how. The aim of this scoping review was to identify for mental health services, what user-provider partnerships are, how they arise in practice and what can facilitate or hinder them. METHODS A scoping review was conducted to obtain a broad overview of user provider partnerships in severe mental illness. Data was inductively analysed using a conventional content analysis approach, in which meaning was found in the texts. RESULTS In total, 1559 titles were screened for the eligibility criteria and the resulting 22 papers found relevant were analysed using conventional content analysis. The identified papers had broad and differing concepts for user-provider partnerships. Papers considered shared decision making and user-involvement as partnerships. Mechanisms such as open communication, organisational top-down support and active participation supported partnerships, but professional identity, power imbalances and stress hindered them. Users can be impeded by their illness, but how to deal with these situations should be formalised through contracts. CONCLUSION The field of research around user-provider partnerships is scattered and lacks consensus on terminology. A power imbalance between a user and a provider is characteristic of partnerships in mental healthcare, which hinders the necessary relationship building allowing partnerships to arise. This power imbalance seems to be closely linked to professional identity, which was found to be difficult to change.
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Affiliation(s)
- Aletta Boerkoel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. .,Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.
| | - Mats Brommels
- grid.465198.7Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
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11
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Ko CJ, Huang HL, Gao ZT, Chiang HH. Re-figuration of suffering: Transitional phenomena of people living with schizophrenia in group analysis. Arch Psychiatr Nurs 2022; 39:13-19. [PMID: 35688539 DOI: 10.1016/j.apnu.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
This study examined how people living with schizophrenia recognize their lived experiences in free-floating group discussions. Interpretative phenomenological and group analyses were employed to collect qualitative data from 14 patients. The identified superordinate theme was "re-figuration of suffering" including: "being treated as an object," "encountering the self through others," and "returning to the self." Participants shared their traumatizing stories of being alienated, discovered the realities of their lives and responsibilities through inward and outward observations, and progressed to a self-returning stage while regaining their appreciation of others and hope for the future. The contributions of psychiatric nursing practice were identified.
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Affiliation(s)
- Chen Ju Ko
- School of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan, ROC.
| | - Hseuh-Li Huang
- Department of Medical Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, ROC
| | - Zih Ting Gao
- Department of Nursing, Tongxin Long-term Health Care Center, Taoyuan, Taiwan, ROC
| | - Hsien-Hsien Chiang
- School of Nursing, National Yang Ming Chiao Tung University, Taiwan, ROC.
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12
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Siafis S, Bursch N, Müller K, Schmid L, Schuster F, Waibel J, Huynh T, Matthes F, Rodolico A, Brieger P, Bühner M, Heres S, Leucht S, Hamann J. Evidence-based Shared-Decision-Making Assistant (SDM-assistant) for choosing antipsychotics: protocol of a cluster-randomized trial in hospitalized patients with schizophrenia. BMC Psychiatry 2022; 22:406. [PMID: 35715740 PMCID: PMC9204887 DOI: 10.1186/s12888-022-04036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Choosing an antipsychotic medication is an important medical decision in the treatment of schizophrenia. This decision requires risk-benefit assessments of antipsychotics, and thus, shared-decision making between physician and patients is strongly encouraged. Although the efficacy and side-effect profiles of antipsychotics are well-established, there is no clear framework for the communication of the evidence between physicians and patients. For this reason, we developed an evidence-based shared-decision making assistant (SDM-assistant) that presents high-quality evidence from network meta-analysis on the efficacy and side-effect profile of antipsychotics and can be used as a basis for shared-decision making between physicians and patients when selecting antipsychotic medications. METHODS The planned matched-pair cluster-randomised trial will be conducted in acute psychiatric wards (n = 14 wards planned) and will include adult inpatients with schizophrenia or schizophrenia-like disorders (N = 252 participants planned). On the intervention wards, patients and their treating physicians will use the SDM-assistant, whenever a decision on choosing an antipsychotic is warranted. On the control wards, antipsychotics will be chosen according to treatment-as-usual. The primary outcome will be patients' perceived involvement in the decision-making during the inpatient stay as measured with the SDM-Q-9. We will also assess therapeutic alliance, symptom severity, side-effects, treatment satisfaction, adherence, quality of life, functioning and rehospitalizations as secondary outcomes. Outcomes could be analysed at discharge and at follow-up after three months from discharge. The analysis will be conducted per-protocol using mixed-effects linear regression models for continuous outcomes and logistic regression models using generalised estimating equations for dichotomous outcomes. Barriers and facilitators in the implementation of the intervention will also be examined using a qualitative content analysis. DISCUSSION This is the first trial to examine a decision assistant specifically designed to facilitate shared-decision making for choosing antipsychotic medications, i.e., SDM-assistant, in acutely ill inpatients with schizophrenia. If the intervention can be successfully implemented, SDM-assistant could advance evidence-based medicine in schizophrenia by putting medical evidence on antipsychotics into the context of patient preferences and values. This could subsequently lead to a higher involvement of the patients in decision-making and better therapy decisions. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00027316 , registration date 26.01.2022).
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Nicola Bursch
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Lisa Schmid
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Schuster
- grid.476609.a0000 0004 0477 3019Schön Klinik Roseneck, Rosenheim, Germany
| | - Jakob Waibel
- grid.6936.a0000000123222966Department of Informatics, Technical University of Munich, Munich, Germany
| | - Tri Huynh
- grid.6936.a0000000123222966Department of Informatics, Technical University of Munich, Munich, Germany
| | - Florian Matthes
- grid.6936.a0000000123222966Department of Informatics, Technical University of Munich, Munich, Germany
| | - Alessandro Rodolico
- grid.8158.40000 0004 1757 1969Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | | | - Markus Bühner
- grid.5252.00000 0004 1936 973XPsychological Methodology and Diagnostics, Ludwig Maximilian University, Munich, Germany
| | | | - Stefan Leucht
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Hamann
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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13
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Tang C, Wang A, Yan J. Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model. Health Expect 2022; 25:1254-1268. [PMID: 35662361 PMCID: PMC9327808 DOI: 10.1111/hex.13541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM. METHODS A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model. RESULTS From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome. The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension. Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. CONCLUSIONS The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low- and middle-income countries. Furthermore, we consider it important to understand more about the interactions among the factors to take integrated measures to address the problems and to ensure the effectiveness of implementing SDM. PATIENT OR PUBLIC CONTRIBUTION Patients, healthcare professionals and other stakeholders articulated their perspectives on the implementation of SDM actively, and these were adopted and analysed in this study. However, the above-mentioned individuals were not directly involved in the process of this study. Protocol was registered on PROSPERO (CRD42021259309).
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Affiliation(s)
- Changhai Tang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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14
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Haugom EW, Stensrud B, Beston G, Ruud T, Landheim AS. Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study. BMC Psychiatry 2022; 22:192. [PMID: 35300633 PMCID: PMC8932170 DOI: 10.1186/s12888-022-03849-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is a process where the patient and the health professional collaborate to make decisions based on both the patient's preferences and the best available evidence. Patients with psychotic disorders are less involved in making decisions than they would like. More knowledge of these patients' experiences of SDM may improve implementation. The study aim was to describe and explore experiences of SDM among patients with psychotic disorders in mental health care. METHODS Individual interviews were conducted with ten persons with a psychotic disorder. They were service users of two community mental health centres. The transcribed material was analysed using qualitative content analysis. RESULTS Four-fifths of the participants in this study found that they received insufficient information about their health situation and treatment options. All participants experienced that only one kind of treatment was often presented, which was usually medication. Although the study found that different degrees of involvement were practised, two thirds of the participants had little impact on choices to be made. This was despite the fact that they wanted to participate and felt capable of participating, even during periods of more severe illness. The participants described how important it was that SDM in psychosis was based on a trusting relationship, but stated that it took time to establish such a relationship. CONCLUSIONS This study with ten participants indicates that patients with psychotic disorders experienced that they were not allowed to participate as much as they wanted to and believed they were capable of. Some patients were involved, but to a lesser degree than in SDM. More and better tailored information communicated within a trusting relationship is needed to provide psychotic patients with a better basis for active involvement in decisions about their health care.
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Affiliation(s)
- Espen W. Haugom
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway ,grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Stensrud
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway
| | - Gro Beston
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway
| | - Torleif Ruud
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne S. Landheim
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway ,grid.477237.2Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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15
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Wesseldijk-Elferink IJM, Hendriks AW, van den Heuvel SCGH. Shared decision making in a semi-secluded chronic psychiatric ward: The reflective lifeworld experiences of patients with schizophrenia or schizoaffective disorders and nursing staff. Arch Psychiatr Nurs 2021; 35:519-525. [PMID: 34561068 DOI: 10.1016/j.apnu.2021.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Shared decision making (SDM) enhances recovery-oriented mental healthcare, but literature predominately focuses on doctor-patient collaboration leaving the role of mental health nurses (MHN's) underexposed. AIM This study describes the experiences of patients with schizophrenia or schizoaffective disorder with SDM in a semi-secluded psychiatric facility, and the attitudes toward SDM by MHN's. METHOD A hermeneutic phenomenological design. RESULTS Seven patients and six MHN's were interviewed. Although MHNs were skeptical to utilize SDM, and patients often feel omitted, investing in inter-human contact increased the therapeutic alliance. CONCLUSION Tailored plan making and attainable goal setting, building trust, and providing hope are important incentives to enhance SDM.
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Affiliation(s)
| | - Agnes W Hendriks
- Dimence Group, Outpatient clinic for Anxiety disorders, Depression, Personality disorders, and Complex Trauma, Hardenberg, the Netherlands.
| | - Silvio C G H van den Heuvel
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, the Netherlands; Saxion University of Applied Sciences, Deventer, the Netherlands.
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16
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Zisman-Ilani Y, Chmielowska M, Dixon LB, Ramon S. NICE shared decision making guidelines and mental health: challenges for research, practice and implementation. BJPsych Open 2021; 7:e154. [PMID: 34470688 PMCID: PMC8444056 DOI: 10.1192/bjo.2021.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, USA
| | - Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, USA
| | - Shulamit Ramon
- Department of Allied Health, Midwifery and Social Work, University of Hertfordshire, UK
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Lantta T, Anttila M, Välimäki M. Quality of mental health services and rights of people receiving treatment in inpatient services in Finland: a cross-sectional observational survey with the WHO QualityRights Tool Kit. Int J Ment Health Syst 2021; 15:70. [PMID: 34454537 PMCID: PMC8399820 DOI: 10.1186/s13033-021-00495-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article aims to review the quality of mental health services and the rights of the people receiving treatment in inpatient hospital care in Finland using the World Health Organization's QualityRights Tool Kit as a part of a randomized controlled trial VIOLIN. So far, reports on the QualityRights Tool Kit have mainly been from low- and middle-income countries or countries lacking resources for health services. Reports from countries with well-resourced health care systems, such as the Nordic countries, are still quite few. METHODS A cross-sectional observational survey was conducted on 13 closed inpatient psychiatric wards (acute, rehabilitation, forensic psychiatric) at eight hospitals in Finland. The data for the survey were gathered through a document review, observations, and group interviews among staff members, service users and family members. The STROBE checklist for cross-sectional studies was followed in the reporting. RESULTS Finnish mental health services are partially or fully achieving the standards set by the WHO QualityRights Tool Kit (final scores: 2.5-2.9 out of 3). The highest final score out of the five themes (2.9/3) was achieved under Freedom from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse. The lowest final score out of the five themes (2.5/3) was achieved under the right to exercise legal capacity and the right to personal liberty and the security of person. CONCLUSIONS According to the findings, Finnish mental health services appear to be of high quality. However, we have identified some gaps in quality, which we have addressed in a national randomized controlled trial VIOLIN. Improvements can be realized through shared decision making and relaying information to service users.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, ICT-City, University of Turku, 20014, Turku, Finland
| | - Minna Anttila
- Department of Nursing Science, ICT-City, University of Turku, 20014, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, ICT-City, University of Turku, 20014, Turku, Finland. .,Xiangya Nursing School, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China.
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18
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Gurtner C, Schols JMGA, Lohrmann C, Halfens RJG, Hahn S. Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:531-548. [PMID: 33191536 DOI: 10.1111/jpm.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Shared decision-making is a concept originating in the medical field, and it is ideally based on a trustful relationship between the patient and the health professionals involved. Shared decision-making shows potential to strengthen patient autonomy and encourages patients to become involved in decisions regarding their treatment. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: A universal concept and understanding of shared decision-making with relevance specifically to psychiatric clinical practice could not be identified in the analysed literature. Shared decision-making refers to a process, and how and whether the patient wishes to participate in the decision-making process should be clarified from the very beginning. On the basis of this synthesizing review, a process model for psychiatric practice was specified and illustrated to help lead health professionals, patients and other supporters through the decision-making process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The process of shared decision-making should be made visible to all persons involved, and it should be stated at the beginning that a decision must be made. Decisions regarding treatment are usually not limited to a single consultation. A collaborative approach including multiple health professionals and other supporters, such as peer workers and family members, is required. Psychiatric nurses could support patients during the process of decision-making and provide additional information, if requested. ABSTRACT INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision-making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centred and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.
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Affiliation(s)
- Caroline Gurtner
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine & Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Waddell A, Lennox A, Spassova G, Bragge P. Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review. Implement Sci 2021; 16:74. [PMID: 34332601 PMCID: PMC8325317 DOI: 10.1186/s13012-021-01142-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. Methods The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. Results Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. Conclusions SDM implementation research in hospital settings appears to be a young field. Future research should build on studies examining perspectives beyond the clinician-patient dyad and further consider the role of organisational- and system-level factors. Organisations wishing to implement SDM in hospital settings should also consider factors specific to tertiary care settings in addition to addressing their organisational and individual SDM needs. Trial Registration The protocol for the review is registered on the Open Science Framework and can be found at https://osf.io/da645/, DOI 10.17605/OSF.IO/DA645. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01142-y.
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Affiliation(s)
- Alex Waddell
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Melbourne, VIC, 3800, Australia. .,Safer Care Victoria, 50 Lonsdale St, Melbourne, VIC, 3000, Australia.
| | - Alyse Lennox
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Melbourne, VIC, 3800, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Level 6, Building S, Caulfield Campus 26 Sir John Monash Drive, Caulfield East, VIC, 3145, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Melbourne, VIC, 3800, Australia
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20
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Becher S, Holzhüter F, Heres S, Hamann J. Barriers and facilitators of shared decision making in acutely ill inpatients with schizophrenia-Qualitative findings from the intervention group of a randomised-controlled trial. Health Expect 2021; 24:1737-1746. [PMID: 34258833 PMCID: PMC8483208 DOI: 10.1111/hex.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/04/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Shared decision making (SDM) is appreciated as a promising model of communication between clinicians and patients. However, in acute mental health settings, its implementation is still unsatisfactory. Objective The aim of this study is to examine barriers and facilitators of SDM with acutely ill inpatients with schizophrenia. Design A qualitative interview study was performed. Setting and Participants The analysis is based on interviews with participants (patients and staff members) of the intervention group of the randomised‐controlled SDMPLUS trial that demonstrated a significant improvement of SDM measures for patients with schizophrenia on acute psychiatric wards. Main Variables Studied Interviews addressed treatment decisions made during the current inpatient stay. The interviews were analysed using qualitative content analysis. Results A total of 40 interviews were analysed and 131 treatment decisions were identified. According to the interviewees, SDM had taken place in 29% of the decisions, whereas 59% of the decisions were made without SDM. In 16%, a clear judgement could not be made. Barriers and facilitators of SDM were categorised into patient factors, clinician factors, setting factors and others. Clinicians mostly reported patient factors (e.g., symptoms) as barriers towards SDM, which were not mirrored on the patients' side. Facilitators included patient as well as clinician behaviour during consultations. Conclusion Even in the context of a successful SDM intervention, the implementation of SDM for patients in the very acute stages of schizophrenia is often not possible. However, strong facilitators for SDM have also been identified, which should be used for further implementation of SDM. Patient or Public Contribution During the development of the study protocol, meetings with user representatives were held.
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Affiliation(s)
- Stefanie Becher
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | - Fabian Holzhüter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | | | - Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
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21
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Hasson‐Ohayon I, Jong S, Igra L, Carter SA, Faith LA, Lysaker P. Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments. Clin Psychol Psychother 2021; 28:1243-1253. [DOI: 10.1002/cpp.2572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Libby Igra
- Department of Psychology Bar‐Ilan University Ramat‐Gan Israel
| | - Sarah A. Carter
- Utrecht University: University College Roosevelt Middelburg The Netherlands
| | - Laura A. Faith
- Department of Psychology University of Missouri‐Kansas City Kansas City Missouri USA
| | - Paul Lysaker
- Department of Psychiatry Roudebush VA Medical Center and the Indiana University School of Medicine Indianapolis Indiana USA
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22
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Hopwood M. The Shared Decision-Making Process in the Pharmacological Management of Depression. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:23-30. [PMID: 31544218 PMCID: PMC6957572 DOI: 10.1007/s40271-019-00383-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Shared decision making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. There is an international consensus across medicine about the importance of SDM interventions, which have raised great interest in mental healthcare over the last decade. Yet SDM is not widely adopted, particularly in the field of psychiatry. The purpose of the present article is to examine, from a patient and physician perspective, the importance of SDM in the management of healthcare with a focus on mental health; it reviews the enablers and barriers (and how to overcome them) to implementing a SDM process in psychiatric practice. SDM models have been developed recently for involving patients with depression in the decision-making process, which could result in augmenting the proportion of patients who adhere to their antidepressant or other treatments for a duration that complies with the current recommendations. To implement this approach, more physicians need training in the SDM approach and access to appropriate tools that help engage in collaborative deliberation, and practice generally needs to be reorganized around the principles of patient engagement.
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Affiliation(s)
- Malcom Hopwood
- Albert Road Clinic, University of Melbourne, Melbourne, Australia.
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Aoki Y. Shared decision making for adults with severe mental illness: A concept analysis. Jpn J Nurs Sci 2020; 17:e12365. [PMID: 32761783 PMCID: PMC7590107 DOI: 10.1111/jjns.12365] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 06/27/2020] [Indexed: 12/01/2022]
Abstract
AIM Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. METHODS Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. RESULTS Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship. CONCLUSIONS Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
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Affiliation(s)
- Yumi Aoki
- Psychiatric & Mental Health Nursing, Graduate School of NursingSt. Luke's International UniversityTokyoJapan
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Hamann J, John M, Holzhüter F, Siafis S, Brieger P, Heres S. Shared decision making, aggression, and coercion in inpatients with schizophrenia. Eur Psychiatry 2020; 63:e90. [PMID: 32981554 PMCID: PMC7576528 DOI: 10.1192/j.eurpsy.2020.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The present study aimed at answering three research questions: (a) Does shared decision making (SDM) yield similar effects for patients with involuntary admission or incidents of aggression compared to patients with voluntary admission or without incidents of aggression? (b) Does SDM reduce the number of patients with incidents of aggression and the use of coercive measures? (c) Does the use of coercion have a negative impact on patients’ perceived involvement in decision making? Methods We used data from the cluster-randomized SDM-PLUS trial in which patients with schizophrenia or schizoaffective disorder in 12 acute psychiatric wards of 4 German psychiatric hospitals either received an SDM-intervention or treatment as usual. In addition, data on aggression and coercive measures were retrospectively obtained from patients’ records. Results The analysis included n = 305 inpatients. Patient aggression as well as coercive measures mostly took place in the first days of the inpatient stay and were seldom during the study phase of the SDM-PLUS trial. Patients who had been admitted involuntarily or showed incidents of aggression profited similarly from the intervention with regard to perceived involvement, adherence, and treatment satisfaction compared to patients admitted voluntarily or without incidents of aggression. The intervention showed no effect on patient aggression and coercive measures. Having previously experienced coercive measures did not predict patients’ rating of perceived involvement. Conclusion Further research should focus on SDM-interventions taking place in the very first days of inpatients treatment and potential beneficial long effects of participatory approaches that may not be measurable during the current inpatient stay.
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Affiliation(s)
- Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Miriam John
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Fabian Holzhüter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Spyridon Siafis
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Sikstrom L, Meyer T, Katz E, Choi MM, Darragh M, Cutler-Palma A, Conforti T, Kalocsai C, Soklaridis S. Increasing participation in research with therapy dogs: A qualitative study at a large urban mental health and addiction hospital. PLoS One 2020; 15:e0238096. [PMID: 32853258 PMCID: PMC7451510 DOI: 10.1371/journal.pone.0238096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/09/2020] [Indexed: 11/19/2022] Open
Abstract
The benefits of involving patients as partners in research across diverse medical and psychiatric settings are well established in the literature. However, researchers continue to struggle to access, engage and retain participants from hard-to-reach populations. The main objective of this study was to co-create pet therapy activities with patients admitted for serious and complex mental illness to a large urban mental health and addiction hospital. Informed by the principles of participatory action research methodology, we conducted focus group discussions with 38 inpatients in seven different clinical units. An experienced volunteer handler and a certified therapy dog helped facilitate our discussions. Participating researchers, recreational therapists, volunteer handlers and our participants all reported that the presence of a certified therapy dog at each of our discussions was integral to their success. Certified therapy dogs increased the motivation to participate in our study, helped to build rapport with participants and created connections in our discussions that enriched our data. To our knowledge our study is the first to demonstrate the value of using a therapy dog as a participatory research tool in a healthcare setting. The authors believe that therapy dogs are a low-tech intervention that could be used effectively to engage hard-to-reach populations in research about their treatment and care in a diverse range of medical settings. These findings support the creation of a pilot study to test the value of including therapy dogs in patient-centered research with vulnerable and hard-to-reach populations.
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Affiliation(s)
- Laura Sikstrom
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tamar Meyer
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Eva Katz
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Man-Man Choi
- Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Margaret Darragh
- Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amanda Cutler-Palma
- Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Theresa Conforti
- Volunteer Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Csilla Kalocsai
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Psychiatry and Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre, University Health Network and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Implementing shared decision-making on acute psychiatric wards: a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS). Epidemiol Psychiatr Sci 2020; 29:e137. [PMID: 32539907 PMCID: PMC7303792 DOI: 10.1017/s2045796020000505] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM-PLUS). METHODS The study is a multi-centre, cluster-randomised, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of five psychiatric hospitals addressing inpatients with schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under 'treatment as usual' conditions. The primary outcome parameter was the patients' perceived involvement in decision-making at 3 weeks after study enrolment, analysed using a random-effects linear regression model. RESULTS In total, 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision-making (primary outcome, analysed patients n = 257, mean group difference 16.5, 95% CI 9.0-24.0, p = 0.002, adjusted for baseline differences: β 17.3, 95% CI 10.8-23.6, p = 0.0004). In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalisation rates in the 6- and 12-month follow-up. CONCLUSIONS Despite limitations in patient recruitment, the SDM-PLUS trial has shown that the adoption of behavioural approaches (e.g. motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment.Trial registration: The trial was registered at Deutsches Register Klinischer Studien (DRKS00010880).
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Morán-Sánchez I, Bernal-López MA, Pérez-Cárceles MD. Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 2020; 55:571-580. [PMID: 31728560 DOI: 10.1007/s00127-019-01809-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Participation in medical decisions and taking into account patients' values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings. METHODS Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used. RESULTS 70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences. CONCLUSIONS Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.
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Affiliation(s)
- Inés Morán-Sánchez
- Mental Health Centre, Health Service of Murcia, CSM Cartagena, Calle Real, 8, 30201, Murcia, Spain.
| | - María A Bernal-López
- Mental Health Centre, Health Service of Murcia, CSM Cartagena, Calle Real, 8, 30201, Murcia, Spain
| | - Maria D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, Spain
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Huang C, Plummer V, Lam L, Cross W. Perceptions of shared decision-making in severe mental illness: An integrative review. J Psychiatr Ment Health Nurs 2020; 27:103-127. [PMID: 31444919 DOI: 10.1111/jpm.12558] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022]
Abstract
WHAT IS KNOWN ABOUT SHARED DECISION-MAKING?: There is increasing evidence of the positive impact of shared decision-making on health outcomes. There has been little exploration of shared decision-making regarding people diagnosed with serious mental illness from the perspectives of key stakeholders including consumers, families and mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Consumers show variability in the preference for their involvement. Most stakeholders acknowledge the importance of family involvement. MHPs should share the responsibility and right to facilitate consumer involvement. There is bidirectional association between shared decision-making and therapeutic relationships. The practice of shared decision-making is related to multiple factors, and one main perceived barrier is time. The majority of studies are from Western countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Elicit consumer preferences and establish a collaborative therapeutic relationship. Encourage and engage families in treatment decision-making. Inter-professional collaboration should be integrated into shared decision-making. It might require lengthier consultation time. Studies in non-Western countries are needed to fully understand the impact of culture on shared decision-making. Abstract Introduction Shared decision-making (SDM) has been broadly advocated in health services and constitutes an important component of patient-centred care and relationship-based care. Aim To review available literature related to perceptions of key stakeholders about shared decision-making in serious mental illness. Method An integrative review was conducted through a search of four online databases from January 2012 to June 2019. Results Forty-six articles were included. Six themes were generated from the data analysis: (a) dynamic preferences for SDM, (b) various stakeholders are rarely involved, (c) SDM is not routinely implemented, (d) multiple facilitators and barriers to SDM, (e) SDM and therapeutic relationships interact, (f) SDM has a promising impact on health outcomes. Discussion Overall, most stakeholders have recognized the importance and flexibility of SDM in serious mental illness, although it is not routine in mental health service. Consumer preferences show variability in their involvement. Most stakeholders acknowledged the importance of family involvement to treatment decision-making. There are several significant challenges to practice SDM. It may require extended consultation times and increasing empirical evidence regarding the SDM outcomes, as well as integrating inter-professional collaboration into SDM. Most studies were conducted in Western culture. Implications for practice Mental health nurses should elicit consumer preferences and establish a collaborative therapeutic relationship. Encourage and engage families in treatment decision-making when consumers prefer their families to be involved. Inter-professional collaboration should be integrated into shared decision-making. The practice of shared decision-making might need extended consultation time and more robust evidence about the outcome of shared decision-making. Studies in non-Western cultures are needed to fully understand cultural issues of shared decision-making.
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Affiliation(s)
- Chongmei Huang
- School of Nursing & Midwifery, Monash University, Clayton, Victoria
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University and Peninsula Health, Frankston, Victoria
| | - Louisa Lam
- School of Nursing and Healthcare Professions, Federation University Australia, Melbourne, Victoria
| | - Wendy Cross
- School of Nursing and Healthcare Professions, Federation University Australia, Melbourne, Victoria
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Mucci A, Kawohl W, Maria C, Wooller A. Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Front Psychiatry 2020; 11:761. [PMID: 32903708 PMCID: PMC7438851 DOI: 10.3389/fpsyt.2020.00761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/17/2020] [Indexed: 11/13/2022] Open
Abstract
Integrated pharmacological and psychosocial treatments, such as psychoeducation (PE) and shared decision-making (SDM), have been shown to significantly improve outcomes for people living with schizophrenia (PLWS). Underpinning the success of these interventions is a strong therapeutic relationship between PLWS, their carers, and their healthcare team. While many recognize the value of this relationship, implementation of the interventions necessary to facilitate its construction remain low. In this article, we identify the barriers to developing productive therapeutic relationships and explain how PE and SDM, taking into account cultural difference, can improve adherence to treatment, strengthen therapeutic relationships, and ultimately equip patients to achieve better functional outcomes.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, PDAG, Brugg, University of Zurich, Zurich, Switzerland
| | - Cristiana Maria
- Communications EMEA, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Annette Wooller
- Medical Affairs EMEA, Janssen Pharmaceuticals, High Wycombe, United Kingdom
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Kaar SJ, Gobjila C, Butler E, Henderson C, Howes OD. Making decisions about antipsychotics: a qualitative study of patient experience and the development of a decision aid. BMC Psychiatry 2019; 19:309. [PMID: 31646985 PMCID: PMC6806500 DOI: 10.1186/s12888-019-2304-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shared decision making is a widely accepted standard of patient-centred care that leads to improved clinical outcomes, yet it is commonly underutilised in the field of mental health. Furthermore, little is known regarding patient decision making around antipsychotic medication, which is often poorly adhered to. We aim to explore psychiatric patients' experiences of antipsychotic medication decision making in order to develop a patient decision aid to promote shared decision making. METHODS Focus groups were conducted with patients with chronic psychotic illnesses (n = 20) who had previously made a decision about taking or changing antipsychotic medication. Transcripts were coded and analysed for thematic content and continued until thematic saturation. These themes subsequently informed the development of a decision aid with the help of expert guidance. Further patient input was sought using the think aloud method (n = 3). RESULTS Twenty-three patients participated in the study. Thematic analysis revealed that 'adverse effects' was the most common theme identified by patients surrounding antipsychotic medication decision-making followed by 'mode and time of administration', 'symptom control' and 'autonomy'. The final decision aid is included to provoke further discussion and development of such aids. CONCLUSIONS Patients commonly report negative experiences of antipsychotic medication, in particular side-effects, which remain critical to future decision making around antipsychotic medication. Clinical encounters that increase patient knowledge and maximise autonomy in order to prevent early negative experiences with antipsychotic medication are likely to be beneficial.
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Affiliation(s)
- S J Kaar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, PO63 De Crespigny Park, London, SE5 8AF, UK.
| | - C Gobjila
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, PO63 De Crespigny Park, London, SE5 8AF, UK
| | - E Butler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, PO63 De Crespigny Park, London, SE5 8AF, UK
| | - C Henderson
- Health Service and Population Research, Psychological and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8AZ, UK
| | - O D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, PO63 De Crespigny Park, London, SE5 8AF, UK.,Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College, Hammersmith Hospital, London, UK
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Stip E, Abdel-Baki A, Roy MA, Bloom D, Grignon S. [Long-acting antipsychotics: The QAAPAPLE algorithm review]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:697-707. [PMID: 31088133 PMCID: PMC6783667 DOI: 10.1177/0706743719847193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Eight years ago, a committee of experts from 4 Quebec university psychiatry departments has provided the QAAPAPLE algorithm in order to guide clinicians in their use of long-acting antipsychotics (LAAP) for patients with psychotic disorders. OBJECTIVE Update the QAAPAPLE algorithm. METHODS Using a qualitative and selective literature review, the experts have focused on several aspects related to the use of LAAP and the relevance of modifying the algorithm: 1) new data on LAAP (including polypharmacy and co-prescription with clozapine, dose frequency/interval); 2) perception and attitude regarding algorithms and evidence; 3) difficulties in implementing algorithms; 4) polypharmacy involving LAAP and co-prescriptions with clozapine; 5) partner patients perspective on the algorithm. RESULTS Thirteen meta-analysis were published and completed observational studies (including those on national registries), confirming the LAAP benefits. Literature adds specifications about using some drug associations as well as dose frequency and interval. Therefore, scientific advances have been considered to modify the algorithm. CONCLUSION Interacting with Quebec psychiatrists, we have examined changes in prescription and literature to better understand the use of algorithm. The committee has updated the QAAPAPLE algorithm to guide clinicians in using LAAP along the path of patients with psychosis as early as the first episode and through different clinical settings (including treatment resistance) in order to have a more flexible and user-friendly treatment.
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Affiliation(s)
- Emmanuel Stip
- Professeur titulaire de psychiatrie, département de psychiatrie de l'Université de Montréal, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Professeur titulaire de clinique, Université de Montréal, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.,chercheure Centre de recherche CHUM, Montreal, Québec, Canada
| | - Marc-André Roy
- Professeur agrégé, département de Psychiatrie et Neurosciences, Université Laval; chercheur, centre de recherche CERVO, directeur médical, Clinique Notre-Dame des Victoires, Québec, Québec, Canada
| | - David Bloom
- Chef médical, Programme de déficience intellectuelle avec comorbidité psychiatrique, Chef médical, Programme des troubles psychotiques, Professeur adjoint, département de psychiatrie, Université McGill, Montréal, Québec, Canada
| | - Sylvain Grignon
- Professeur titulaire, Département de Psychiatrie, Université de Sherbrooke, Sherbrooke, Québec, Canada
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[Shared decision-making in acute psychiatric medicine : Contraindication or a challenge?]. DER NERVENARZT 2019; 88:995-1002. [PMID: 28597029 DOI: 10.1007/s00115-017-0359-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The concept of shared decision-making (SDM) has existed since the 1990s in multiple fields of somatic medicine but has only been poorly applied in psychiatric clinical routine despite broad acceptance and promising outcomes in clinical studies on its positive effects. MATERIALS AND METHODS The concept itself and its practicability in mental health are carefully assessed and strategies for its future implementation in psychiatric medicine are presented in this article. Ongoing clinical studies probing some of those strategies are further outlined. RESULTS AND DISCUSSION On top of the ubiquitous shortage of time in clinical routine, psychiatrists report their concern about patients' limited abilities in sharing decisions and their own fear of potentially harmful decisions resulting from a shared process. Misinterpretation of shared decision-making restricting the health care professional to rather an informed choice scenario and their own adhesion to the traditional paternalistic decision-making approach further add to SDM's underutilization. Those hurdles could be overcome by communication skill workshops for all mental health care professionals, including nursing personnels, psychologists, social workers and physicians, as well as the use of decision aids and training courses for patients to motivate and empower them in sharing decisions with the medical staff. By this, the patient-centered treatment approach demanded by guidelines, carers and users could be further facilitated in psychiatric clinical routine.
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Nurses' Perceptions of Engaging With Patients to Reduce Restrictive Practices in an Inpatient Psychiatric Unit. Health Care Manag (Frederick) 2018; 37:342-353. [PMID: 30216195 DOI: 10.1097/hcm.0000000000000235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the evidence of harmful effects of restrictive practices on patients and nurses, restrictive practices are still commonly used in the inpatient psychiatric settings. There has been a paradigm shift of a collaborative approach and implementation of patient engagement to reduce the use of restrictive practices. The purpose of this study was to explore nurses' perceptions of engaging with patients to reduce the use of restrictive practices in an inpatient psychiatric unit. This qualitative-descriptive study was conducted on an inpatient psychiatric unit of a large university hospital in Canada. Semistructured individual interviews were conducted with 6 nurses in 2016. Data generated by the interviews were coded and analyzed by thematic analysis. Four major themes emerged from the data analysis: unit engagement practices, managing the escalation by engaging with patient, engaging during the use of restrictive practices, and factors influencing engaging with patient to reduce restrictive practices. It is concluded that nurses perceive engaging with patients as possible and effective to reduce the use of restrictive practices despite identified barriers.
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Zaini S, Manivanna Bharathy HA, Sulaiman AH, Singh Gill J, Ong Hui K, Zaman Huri H, Shamsudin SH, Chong Guan N. Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071402. [PMID: 29970848 PMCID: PMC6068982 DOI: 10.3390/ijerph15071402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 01/22/2023]
Abstract
Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.
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Affiliation(s)
- Syahrir Zaini
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia.
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Jesjeet Singh Gill
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Koh Ong Hui
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Hasniza Zaman Huri
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Siti Hadijah Shamsudin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia.
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Alguera-Lara V, Dowsey MM, Ride J, Kinder S, Castle D. Shared decision making in mental health: the importance for current clinical practice. Australas Psychiatry 2017; 25:578-582. [PMID: 29017332 DOI: 10.1177/1039856217734711] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. METHODS Narrative review of published English-language articles. RESULTS After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. CONCLUSIONS Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.
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Affiliation(s)
- Victoria Alguera-Lara
- Research Senior Registrar, Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Michelle M Dowsey
- Career Development Fellow, Cepartment of Orthopedics St Vincent's Hospital, Melbourne, VIC, Australia
| | - Jemimah Ride
- Research Fellow, Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Skye Kinder
- Medical Student, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Professor, Department of Psychiatry, St Vincent's Hospital; The University of Melbourne, Melbourne, VIC, Australia
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Viksveen P, Relton C. Depressed patients’ experiences with and perspectives on treatment provided by homeopaths. A qualitative interview study embedded in a trial. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Metz MJ, Elfeddali I, Krol DGH, Veerbeek MA, de Beurs E, Beekman ATF, van der Feltz-Cornelis CM. A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial. BMC Psychiatry 2017; 17:86. [PMID: 28270129 PMCID: PMC5341197 DOI: 10.1186/s12888-017-1247-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/24/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Enhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients' and clinicians' behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes. METHODS This article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake. DISCUSSION This study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment. TRIAL REGISTRATION Trial registration: Dutch Trial Register NTR5677 . Registered 17th January 2016.
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Affiliation(s)
- Margot J. Metz
- 0000 0004 1754 9227grid.12380.38EMGO Institute for Health and Care Research (EMGO+), VU University, Amsterdam, The Netherlands ,GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands
| | - Iman Elfeddali
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands ,0000 0001 0481 6099grid.5012.6School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands ,0000 0001 0943 3265grid.12295.3dTRANZO Department, Tilburg University, Tilburg, The Netherlands
| | - David G. H. Krol
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands
| | - Marjolein A. Veerbeek
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction (Trimbos Institute), P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - Edwin de Beurs
- 0000 0001 2312 1970grid.5132.5Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands ,Foundation Benchmark Mental Health Care, Stichting Benchmark GGZ, Rembrandtlaan 46, 3723 BK Bilthoven, The Netherlands
| | - Aartjan T. F. Beekman
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest, Mental Health Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Christina M. van der Feltz-Cornelis
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands ,0000 0001 0943 3265grid.12295.3dTRANZO Department, Tilburg University, Tilburg, The Netherlands
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Hamann J, Holzhüter F, Stecher L, Heres S. Shared decision making PLUS - a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS). BMC Psychiatry 2017; 17:78. [PMID: 28231777 PMCID: PMC5324213 DOI: 10.1186/s12888-017-1240-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is a model of how doctors and patients interact with each other. It aims at changing the traditional power asymmetry between doctors and patients by strengthening the exchange of information and the decisional position of the patient. Although SDM is generally welcomed by mental health patients as well as by mental health professionals its implementation in routine care, especially in the more acute settings, is still lacking. SDM-PLUS has been developed as an approach that addresses both patients and mental health professionals and aims at implementing SDM even for the very acutely ill patients. METHODS The SDM-PLUS study will be performed as a matched-pair cluster-randomized trial in acute psychiatric wards. On wards allocated to the intervention group personnel will receive communication training (addressing how to implement SDM for various scenarios) and patients will receive a group intervention addressing patient skills for SDM. Wards allocated to the control condition will continue treatment as usual. A total sample size of 276 patients suffering from schizophrenia or schizoaffective disorder on 12 wards is planned. The main outcome parameter will be patients' perceived involvement in decision making during the inpatient stay measured with the SDM-Q-9 questionnaire. Secondary objectives include the therapeutic relationship and long term outcomes such as medication adherence and rehospitalization rates. In addition, process measures and qualitative data will be obtained to allow for the analysis of potential barriers and facilitators of SDM-PLUS. The primary analysis will be a comparison of SDM-Q-9 sum scores 3 weeks after study inclusion (or discharge, if earlier) between the intervention and control groups. To assess the effect of the intervention on this continuous primary outcome, a random effects linear regression model will be fitted with ward (cluster) as a random effect term and intervention group as a fixed effect. DISCUSSION This will be the first trial examining the SDM-PLUS approach for patients with schizophrenia or schizoaffective disorder in very acute mental health inpatient settings. Within the trial a complex intervention will be implemented that addresses both patients and health care staff to yield maximum effects. TRIAL REGISTRATION German Clinical Trials Register DRKS00010880 . Registered 09 August 2016.
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Affiliation(s)
- Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Fabian Holzhüter
- 0000000123222966grid.6936.aKlinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Lynne Stecher
- 0000 0004 0477 2438grid.15474.33Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stephan Heres
- 0000000123222966grid.6936.aKlinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
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Ishii M, Okumura Y, Sugiyama N, Hasegawa H, Noda T, Hirayasu Y, Ito H. Feasibility and efficacy of shared decision making for first-admission schizophrenia: a randomized clinical trial. BMC Psychiatry 2017; 17:52. [PMID: 28166757 PMCID: PMC5294770 DOI: 10.1186/s12888-017-1218-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/31/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The feasibility of shared decision making (SDM) for patients with schizophrenia remains controversial due to the assumed inability of patients to cooperate in treatment decision making. This study evaluated the feasibility and efficacy of SDM in patients upon first admission for schizophrenia. METHODS This was a randomized, parallel-group, two-arm, open-label, single-center study conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. Patients with the diagnosis of schizophrenia upon their first admission were randomized into a SDM intervention group or a usual treatment group in a 1:1 ratio. The primary outcome was patient satisfaction at discharge. The secondary outcomes were attitudes toward medication at discharge and treatment continuation at 6 months after discharge. RESULTS Twenty-four patients were randomly assigned. The trial was prematurely terminated due to slow enrollment. At discharge, the mean score on satisfaction was 23.7 in the SDM group and 22.1 in the usual care group (unadjusted mean difference: 1.6; 95% CI: -5.2 to 2.0). Group differences were not observed in attitude toward medication and treatment continuation. There was no statistically significant difference between the groups for the mean Global Assessment of Functioning score at discharge or length of stay as safety endpoint. CONCLUSIONS No statistical differences were found between the SDM group and usual care group in the efficacy outcomes and safety endpoints. Large trials are needed to confirm the efficacy of the SDM program upon first admission for schizophrenia. TRIAL REGISTRATION The study has been registered with ClinicalTrials.gov as NCT01869660 (registered 27 May, 2013).
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Affiliation(s)
- Mio Ishii
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Yasuyuki Okumura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 1-5-11 Nishishimbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Naoya Sugiyama
- Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka 410-8575 Japan
| | - Hana Hasegawa
- Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka 410-8575 Japan
| | - Toshie Noda
- Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka 410-8575 Japan
| | - Yoshio Hirayasu
- 0000 0001 1033 6139grid.268441.dDepartment of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Hiroto Ito
- 0000 0004 1763 8916grid.419280.6Department of Social Psychiatry, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502 Japan
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Huerta-Ramos E, Escobar-Villegas MS, Rubinstein K, Unoka ZS, Grasa E, Hospedales M, Jääskeläinen E, Rubio-Abadal E, Caspi A, Bitter I, Berdun J, Seppälä J, Ochoa S, Fazekas K, Corripio I, Usall J. Measuring Users' Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study. JMIR Mhealth Uhealth 2016; 4:e112. [PMID: 27682896 PMCID: PMC5062002 DOI: 10.2196/mhealth.5716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/29/2016] [Accepted: 08/21/2016] [Indexed: 12/25/2022] Open
Abstract
Background Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. Objective The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). Methods Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. Results A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. Conclusions Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact.
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Fuller SM, Koester KA, Guinness RR, Steward WT. Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics. J Assoc Nurses AIDS Care 2016; 28:75-84. [PMID: 27712863 DOI: 10.1016/j.jana.2016.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022]
Abstract
Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care.
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Alvarez K, Wang Y, Alegria M, Ault-Brutus A, Ramanayake N, Yeh YH, Jeffries JR, Shrout PE. Psychometrics of shared decision making and communication as patient centered measures for two language groups. Psychol Assess 2016; 28:1074-86. [PMID: 27537002 PMCID: PMC5431590 DOI: 10.1037/pas0000344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | | | - Natasha Ramanayake
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Yi-Hui Yeh
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
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Abstract
PURPOSE OF REVIEW This review explores the concept of person-centred care, giving particular attention to its application in mental health and its relationship to recovery. It then outlines a framework for understanding the variety of approaches that have been used to operationalize person-centred care, focusing particularly on shared decision-making and self-directed care, two practices that have significant implications for mental health internationally. RECENT FINDINGS Despite growing recognition of person-centred care as an essential component of recovery-orientated practice, the levels of uptake of shared decision-making and self-directed care in mental health remain low. The most significant barrier appears to be the challenge presented to service providers by one of the key principles of person-centred care, namely empowerment. SUMMARY Shared decision-making and self-directed support, two practices based upon the principles of person-centred care, have the potential for being effective tools for recovery. Full engagement of clinicians is crucial for their successful uptake into practice. More research is needed to address both outcomes and implementation.
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