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Downs J, Keeley J, Skoss R, Mills J, Nevill T, Schippers A, Lindly O, Thompson S. Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability. Int J Equity Health 2024; 23:119. [PMID: 38849806 PMCID: PMC11162048 DOI: 10.1186/s12939-024-02204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and healthcare professionals need to balance listening to a child's wishes with the responsibility of keeping them safe. However, there is a scarcity of literature evaluating how to effectively involve them in decision making. In this context, we review the concept of health literacy, focusing on the skills of healthcare decision making for children and adolescents with intellectual disability. METHODS We describe the concept of health literacy and models explaining shared decision making (individuals and healthcare professionals collaborate in decision making process) and supported decision making (when a trusted person supports the individual to collaborate with the healthcare professional in the decision-making process), and a rapid review of the literature evaluating their efficacy. We discuss healthcare decision making for children and adolescents with intellectual disability in the context of relevant recommendations from the recent Disability Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability in Australia. RESULTS Health literacy skills enable individuals to access, understand, appraise, remember and use health information and services. Shared decision making has been described for children with chronic conditions and supported decision making for adults with intellectual disability. Decision-making contributes to how individuals appraise and use healthcare. The rapid review found very limited evidence of outcomes where children and adolescents with intellectual disability have been supported to contribute to their healthcare decisions. Recommendations from the Disability Royal Commission highlight current needs for greater efforts to support and build the capacity of individuals with disability to be involved in the decisions that affect their life, including healthcare decision making. CONCLUSIONS Existing rights frameworks and healthcare standards confirm the importance of providing all people with the opportunities to learn and practise health literacy skills including decision making. There is little literature examining interventions for healthcare decision making for children with intellectual disability. Childhood is a critical time for the development of skills and autonomy. Evidence for how children and adolescents with intellectual disability can learn and practice healthcare decision-making skills in preparation for adulthood is needed to reduce inequities in their autonomy.
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Affiliation(s)
- Jenny Downs
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia.
- Curtin School for Allied Health, Curtin University, Perth, Australia.
| | - Jessica Keeley
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rachel Skoss
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | | | - Thom Nevill
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Alice Schippers
- Disability Studies, Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands
| | - Olivia Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
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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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Howe J, MacPhee M, Duddy C, Habib H, Wong G, Jacklin S, Oduola S, Upthegrove R, Carlish M, Allen K, Patterson E, Maidment I. A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Qual Saf 2023:bmjqs-2023-016615. [PMID: 38071586 DOI: 10.1136/bmjqs-2023-016615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. OBJECTIVE Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? METHODS A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. RESULTS Our programme theory represents a continuum from a service user's initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. CONCLUSIONS Supported decision-making and trust are foundational to overcoming stigma and establishing 'safety' and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO REGISTRATION NUMBER CRD42021280980.
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Affiliation(s)
- Jo Howe
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Duddy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hafsah Habib
- Pharmacy School, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Max Carlish
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Patterson
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Cassivi C, Sergerie-Richard S, Saint-Pierre B, Goulet MH. Crisis plans in mental health: A scoping review. Int J Ment Health Nurs 2023; 32:1259-1273. [PMID: 37098744 DOI: 10.1111/inm.13158] [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: 09/02/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.
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Affiliation(s)
- Christine Cassivi
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
| | - Sophie Sergerie-Richard
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Institut universitaire en santé mentale de Montréal (IUSMM), Québec, Montréal, Canada
| | - Benoît Saint-Pierre
- Centre intégré universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Québec, Montréal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
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Scholten M, Gather J, Vollmann J. Das kombinierte Modell der Entscheidungsassistenz. DER NERVENARZT 2022; 93:1093-1103. [PMID: 36121451 PMCID: PMC9630234 DOI: 10.1007/s00115-022-01384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Hintergrund Die Auslegung von Artikel 12 der Behindertenrechtskonvention der Vereinten Nationen (Art. 12 UN-BRK) durch den Ausschuss für die Rechte von Menschen mit Behinderungen hat zu einer Kontroverse über die Umsetzung des Artikels in der Psychiatrie geführt. Fragestellung Wie kann Art. 12 UN-BRK auf ethisch vertretbare Weise in der Psychiatrie umgesetzt werden? Material und Methode Es wurde eine empirisch und rechtlich informierte konzeptionelle und ethische Analyse durchgeführt. Ergebnisse Das vorgeschlagene kombinierte Modell der Entscheidungsassistenz gewährleistet die Anerkennung von Menschen mit psychischen Erkrankungen als Rechtssubjekt, deren Gleichbehandlung im Hinblick auf die Erteilung einer Einwilligung sowie die Bereitstellung von Entscheidungsassistenz. Nach diesem Modell dürfen Zwangsbehandlungen nur unter Achtung des Willens und der Präferenzen der Person und weiteren Voraussetzungen der Verhältnismäßigkeit und unabhängiger Überprüfung durchgeführt werden. Schlussfolgerungen Art. 12 UN-BRK kann nach dem kombinierten Modell der Entscheidungsassistenz auf ethisch vertretbare Weise in der Psychiatrie umgesetzt werden.
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Affiliation(s)
- Matthé Scholten
- Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Markstr. 258a, 44799, Bochum, Deutschland.
| | - Jakov Gather
- Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Markstr. 258a, 44799, Bochum, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Jochen Vollmann
- Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Markstr. 258a, 44799, Bochum, Deutschland
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Gumley A, Glasgow A, McInnes G, Jackson C. Mental Health Professionals' Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis. QUALITATIVE HEALTH RESEARCH 2021; 31:2378-2389. [PMID: 34382884 DOI: 10.1177/10497323211036893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples' wishes, enabling people to have their say (to a point), we know what's best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.
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Affiliation(s)
| | | | - Gordon McInnes
- Mental Health Network Greater Glasgow and Clyde, Suite 11, Templeton House, Templeton Business Centre, 62 Temple Street, Glasgow, G401DA
| | - Calum Jackson
- Inpatient Psychology Services, Dykebar Hospital, Grahamston Road, Paisley, PA2 7DE
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Paredes AZ, Hyer JM, Tsilimigras DI, Palmer E, Lustberg MB, Dillhoff ME, Cloyd JM, Tsung A, Ejaz A, Wells-Di Gregorio S, Pawlik TM. Association of pre-existing mental illness with all-cause and cancer-specific mortality among Medicare beneficiaries with pancreatic cancer. HPB (Oxford) 2021; 23:451-458. [PMID: 32843275 DOI: 10.1016/j.hpb.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/20/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Among patients with pancreatic cancer, the association of pre-existing mental illness with long-term outcomes remains unknown. METHODS Individuals diagnosed with pancreatic adenocarcinoma were identified in the SEER-Medicare database. Patients were classified as having mental illness if an ICD9/10CM code for anxiety, depression, bipolar disorder, schizophrenia or other psychotic disorder was recorded. RESULTS Among the 54,234 Medicare beneficiaries with pancreatic cancer, roughly 1 in 12 (n = 4793, 8.83%) individuals had a diagnosis of a mental illness. The majority (n = 4029, 84.1%) had anxiety or depression, while 16% (n = 764) had bipolar/schizophrenic disorders. On multivariable analysis, among patients with early stage cancer, individuals with pre-existing anxiety/depression and bipolar/schizophrenic disorders had 22% (OR 0.78, 95% CI 0.69-0.86) and 46% (OR 0.54, 95% CI 0.42-0.70) reduced odds, respectively, to undergo cancer-directed surgery. Furthermore, patients with a pre-existing history of bipolar/schizophrenic disorders had a 20% (HR 1.20, 95% CI 1.21-1.40) higher risk of all-cause mortality and 27% (HR 1.27, 95% CI 1.17-1.37) higher risk of pancreatic cancer-specific mortality compared to individuals without a history of mental illness. CONCLUSION One in twelve patients with pancreatic cancer had a pre-existing mental illness. Individuals with mental illness were more likely to have worse overall and cancer-specific long-term outcomes.
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Affiliation(s)
- Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Elizabeth Palmer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Maryam B Lustberg
- Division of Medical Oncology, Supportive Care Services, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 1250 Lincoln Tower, Columbus, OH 43210, USA
| | - Mary E Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, College of Medicine, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 504 McCampbell Hall North, 1581 Dodd Drive, Columbus, OH 43210, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA.
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Gather J, Juckel G, Henking T, Efkemann SA, Vollmann J, Scholten M. Under which conditions are changes in the treatment of people under involuntary commitment justified during the COVID-19 pandemic? An ethical evaluation of current developments in Germany. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 73:101615. [PMID: 33181473 PMCID: PMC9190307 DOI: 10.1016/j.ijlp.2020.101615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 05/28/2023]
Abstract
The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the context of the treatment of people under involuntary commitment. The question arises at various points in the procedure for and process of involuntary commitment whether procedural modifications or further restrictive measures are necessary to minimise the spread of COVID-19 and protect all people involved from infection. In the light of current developments in Germany, this article examines under which conditions changes in the treatment of people under involuntary commitment are ethically justified in view of the COVID-19 pandemic. Among others, we discuss ethical arguments for and against involuntary commitments with reference to COVID-19, the use of different coercive interventions, the introduction of video hearings, an increased use of video surveillance and interventions based on the German Infection Protection Act. We argue that strict hygiene concepts, the provision of sufficient personal protective equipment and frequent testing for COVID-19 should be the central strategies to ensure the best possible protection against infection. Any further restrictions of the liberty of people under involuntary commitment require a sound ethical justification based on the criteria of suitability, necessity and proportionality. A strict compliance with these criteria and the continued oversight by external and independent control mechanisms are important to prevent ethically unjustified restrictions and discrimination against people with the diagnosis of a mental disorder during the COVID-19 pandemic.
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Affiliation(s)
- J Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany.
| | - G Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany
| | - T Henking
- University of Applied Sciences Würzburg-Schweinfurt, Germany
| | - S A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany
| | - J Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany
| | - M Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany
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