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Aggarwal NK. Pharmaceuticalization and Care Coordination in New York City Outpatient Mental Health. Med Anthropol 2024; 43:383-396. [PMID: 39037498 PMCID: PMC11306980 DOI: 10.1080/01459740.2024.2378092] [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] [Indexed: 07/23/2024]
Abstract
US government quality measures prioritize pharmaceuticalization and care coordination to promote patient treatment adherence. How these measures affect outpatient mental health service delivery and patient-provider communication where psychiatrists and nonphysicians collaborate is understudied. Analyzing 500 hours of participant-observation, 117 appointments, and 98 interviews with 45 new patients and providers, I show that psychiatrists and social workers coordinated care by encouraging medications and seeing two mental health providers as the default treatment, irrespective of patient preferences. Ethnographic perspectives crucially account for models of service delivery and provider behaviors in researching treatment adherence.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University and the New York State Psychiatric Institute, New York, New York, USA
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2
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Okumura S, Katsuki F. Effective provider communication for personal agency in mental health recovery: A cross-sectional study on Japanese users' perspectives. J Psychiatr Ment Health Nurs 2024. [PMID: 38922746 DOI: 10.1111/jpm.13078] [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: 02/24/2024] [Revised: 05/01/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented practices in community-based mental health services are of increasing importance. The recovery journey of individuals with mental illness starts with a sense of agency, and a therapeutic relationship with the providers who support them is a prerequisite. In Japan, the construction of community-based integrated care systems for individuals with mental illness is positioned as a priority health issue, with communication with familiar individuals being particularly important for recovery in Japanese and Asian cultures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first to examine effective communication factors for personal agency in the recovery of individuals with mental illness, focusing on addressing uncertainty about treatment choices and dissatisfaction with decision-making, and considering the user's personal recovery journey. In recovery-oriented practice, it is important to prioritize addressing the emotional aspects of decision-making alongside the mental illness condition, supporting users' self-determination in their unique recovery journeys. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings emphasized the need to actively engage with users' perspectives and emotions, emphasize shared life planning, and foster a therapeutic relationship based on partnership. Providers should approach dialogue as carefully as medication prescriptions, prioritizing the establishment of an effective therapeutic relationship with the user. These characteristics are essential for developing a strong therapeutic relationship and effectively facilitating users' recovery. The findings are applicable not only to nurses but to all mental health service providers, contributing to the advancement of recovery-oriented practice. ABSTRACT INTRODUCTION: Recovery-oriented practice in community-based mental health services is crucial for individuals with mental illness, with communication with familiar individuals being important for recovery in Japanese and Asian cultures. AIM This study aimed to examine effective communication factors for personal agency in recovery by investigating the association between perceived support provided through communication and personal agency of individuals with mental illness. METHOD A cross-sectional study was conducted among community-dwelling Japanese mental health service users, assessing subjective agency, decisional conflict, staff support for personal recovery, activation for mental health self-management, demographic variables and living difficulties. Multiple linear regression analysis identified factors predicting subjective agency, revealing characteristics of effective provider communication for recovery. RESULTS Data from 222 users were analysed, revealing negative correlations between uncertainty about treatment choices and ineffective decision-making with higher subjective agency, while staff support for personal recovery positively correlated with higher subjective agency. DISCUSSION In recovery-oriented practice, prioritizing users' emotional experiences during decision-making and supporting their self-determination in their unique recovery journeys is crucial. IMPLICATIONS FOR PRACTICE Providers should approach dialogue as carefully as medication prescriptions, prioritizing therapeutic partnerships with users. The findings extend beyond nursing to all mental health service providers, advancing the theory of recovery-oriented practice.
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Affiliation(s)
- Satoshi Okumura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fujika Katsuki
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, Nagoya, Japan
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3
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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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4
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Kassam A, Beder M, Sediqzadah S, Levy M, Ritts M, Maher J, Kirwan N, Law S. Impact of COVID-19 on the lives of people with severe mental illness-front-line community psychiatry workers observation from a provincial survey of assertive community treatment teams in Ontario, Canada. Int J Ment Health Syst 2023; 17:18. [PMID: 37328776 DOI: 10.1186/s13033-023-00585-8] [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: 10/05/2022] [Accepted: 05/23/2023] [Indexed: 06/18/2023] Open
Abstract
Using an online survey distributed to members of the provincial organization that represents the 88 Assertive Community Treatment (ACT) and Flexible ACT teams in Ontario, Canada, this descriptive study relied on the unique vantage points and observations of the front-line community psychiatry workers who maintained contact with patients through outreach and telecommunication during the height of COVID-19. The patients who suffer from serious mental illness (SMI) were uniquely affected by COVID-19 due to the changes, reduction or shut down of many essential clinical and community support services. Thematic and quantitative analyses of the workers' observations highlighted 6 main areas of note, including significant social isolation and loneliness, clinical course deterioration and life disruption, increased hospital and ER use, police and legal contacts, and substance abuse and related deaths. There were also encouraging signs of positive adaptations in terms of independence and resilience. Reflections of these impacts and potential ameliorating approaches are further discussed.
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Affiliation(s)
- Aly Kassam
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Saadia Sediqzadah
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Matthew Levy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Madeleine Ritts
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - John Maher
- Canadian Mental Health Association, Barrie and Ontario Association of ACT and FACT, Barrie, ON, Canada
| | - Nicole Kirwan
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Samuel Law
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
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5
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Thomas EC, Simmons MB, Mathai C, Salzer MS. Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice. Psychiatr Serv 2023; 74:401-406. [PMID: 36164774 PMCID: PMC10405208 DOI: 10.1176/appi.ps.20220086] [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] [Indexed: 11/30/2022]
Abstract
Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.
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Affiliation(s)
- Elizabeth C. Thomas
- Department of Social and Behavioral Sciences, College of Public Health, Temple University
| | - Magenta B. Simmons
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Chacku Mathai
- Chacku Mathai Consulting LLC
- OnTrackNY and Center for Practice Innovations, Columbia University
| | - Mark S. Salzer
- Department of Social and Behavioral Sciences, College of Public Health, Temple University
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Chmielowska M, Zisman-Ilani Y, Saunders R, Pilling S. Trends, challenges, and priorities for shared decision making in mental health: The first umbrella review. Int J Soc Psychiatry 2023:207640221140291. [PMID: 36680367 DOI: 10.1177/00207640221140291] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental health. AIMS (1) Provide the first systematic analysis of global development trends and challenges of SDM research; (2) clarify the meaning, role, and measurement of SDM in mental health; (3) create a theoretical framework for key effective SDM components to guide future development and implementation of SDM interventions. METHODS A comprehensive search strategy was conducted in CINAHL, PubMed, Scopus, MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, and PsycInfo. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measurement tools, comparisons, and outcomes. RESULTS 10 systematic reviews of SDM in mental health were included with 100 nested studies spanning from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions include treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported. CONCLUSIONS The current landscape of SDM in mental health is overwhelmingly disconnected from the needs and experiences of potential end-users; clients, clinicians, and family members. Most SDM interventions and tools were adapted from physical health and are mainly geared to psychopharmacological decision-making. The SDM in Mental Health Framework (SDM-MH), developed here, expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes of SDM in mental health to reduce heterogeneity across studies.
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Affiliation(s)
- Marta Chmielowska
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,The North East London NHS Foundation Trust Research and Development Department, London, UK.,Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Yaara Zisman-Ilani
- Department of Clinical, Educational and Health Psychology, University College London, UK.,Social and Behavioural Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,Department of Clinical, Educational and Health Psychology, University College London, UK
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Development of the PREMIUM Computerized Adaptive Testing for Measuring the Quality of Information Delivered to Patients with Severe Mental Illnesses. J Clin Med 2022; 11:jcm11226687. [PMID: 36431164 PMCID: PMC9696867 DOI: 10.3390/jcm11226687] [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: 09/23/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Measuring the quality of information delivered to patients with severe mental illness (SMI), i.e., schizophrenia, bipolar disorders, and major depressive disorders, is essential to improve their quality of care. In this work, we described the different steps of the validation of the PREMIUM computerized adaptive testing (CAT) for measuring the quality of information delivered to patients with SMI. The PREMIUM item bank regarding information included 25 items. A total of 499 patients with schizophrenia (53%), bipolar disorders (26%), and major depressive disorders (22%) were recruited from numerous in- and outpatient settings in France. Unidimensionality, local independence, and monotonicity were verified for 19 items of the item bank. The psychometric properties were satisfactory for both internal (RMSEA = 0.069, CFI = 0.969, TLI = 0.963) and external validity (in particular, significant associations were found with age, educational level, and social functioning). The CAT exhibited satisfactory accuracy and precision (standard error of measurement <0.55 and root mean square error <0.3), with an average administration of eight items. This CAT may be used by healthcare professionals in psychiatric settings to accurately assess the patients’ experience with information.
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8
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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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Brodney S, Valentine KD, Vo HA, Cosenza C, Barry MJ, Sepucha KR. Measuring shared decision-making in younger and older adults with depression. Int J Qual Health Care 2022; 34:6717540. [PMID: 36161492 DOI: 10.1093/intqhc/mzac076] [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: 05/05/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study examined the performance of the shared decision-making (SDM) Process scale in patients with depression, compared alternative wording of two items in the scale and explored performance in younger adults. METHODS A web-based non-probability panel of respondents with depression aged 18-39 (younger) or 40-75 (older) who talked with a health-care provider about starting or stopping treatment for depression in the past year were surveyed. Respondents completed one of two versions of the SDM Process scale that differed in the wording of pros and cons items and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider or together). A subset of respondents completed a retest survey by 1 week. We examined how version and age group impacted SDM Process scores and calculated construct validity and retest reliability. We hypothesized that patients with higher SDM Process scores would show less decisional conflict using the SURE scale (range = 0-4); top score = no conflict versus other and less regret (range 1-4; higher scores indicated more regret). RESULTS The sample (N = 494) was majority White, non-Hispanic (82%) and female (72%), 48% were younger and 23% had a high school education or less. SDM Process scores did not differ by version (P = 0.09). SDM Process scores were higher for younger respondents (M = 2.6, SD = 1.0) than older respondents (M = 2.3, SD = 1.1; P = 0.001). Higher SDM Process scores were also associated with no decisional conflict (M = 2.6, SD = 0.99 vs. M = 2.1, SD = 1.2; P < 0.001) and less decision regret (r = -0.18, P < 0.001). Retest reliability was intraclass correlation coefficient = 0.81. CONCLUSIONS The SDM Process scale demonstrated validity and retest reliability in younger adults, and changes to item wording did not impact scores. Although younger respondents reported more SDM, there is room for improvement in SDM for depression treatment decisions.
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Affiliation(s)
- Suzanne Brodney
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - H A Vo
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts, Boston - 100 Morrissey Blvd, Boston, MA 02125, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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10
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Eliacin J, Carter J, Bass E, Flanagan M, Salyers MP, McGuire A. Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation. BMJ Open 2022; 12:e057300. [PMID: 35636799 PMCID: PMC9152945 DOI: 10.1136/bmjopen-2021-057300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units. DESIGN VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data. SETTING 34 VHA inpatient mental health units located in every geographical region of the USA. PARTICIPANTS 55 treatment team members. RESULTS Our results identified an overarching theme of 'power-sharing' that describes participants' conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1) No power sharing: patients are excluded from treatment decisions; (2) Limited power sharing: patients are informed of treatment decisions but have limited influence on the decision-making process; and (3) Shared-power: patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy. CONCLUSIONS Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients' self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.
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Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica Carter
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Emily Bass
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| | - Mindy Flanagan
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| | - Alan McGuire
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
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11
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De Hert M, Loos S, Sterckx S, Thys E, Van Assche K. Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Front Psychiatry 2022; 13:933748. [PMID: 35928783 PMCID: PMC9343580 DOI: 10.3389/fpsyt.2022.933748] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Belgium is one of very few countries that legally allow euthanasia for suffering caused by psychiatric illness. In the first criminal trial in Belgium of physicians involved in euthanasia, three physicians recently faced the accusation of "murder by poisoning," for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law in granting the euthanasia request a woman suffering from psychiatric illness. Although all three physicians were acquitted, the case generated much debate among policy makers, medical professionals, and the general public. METHOD We use this trial as the starting point for a critical analysis of the adequacy of the three-level control system established in the Euthanasia Law, as it is applied in the evaluation of euthanasia requests from persons who suffer unbearably from a psychiatric illness. This analysis is based on information presented during the criminal trial as well as information on the euthanasia that was published in the press. RESULTS Our analysis highlights substantial problems in the assessment and granting of the euthanasia request. The patient was euthanized without it having been substantiated that her psychiatric illness had no prospect of improvement and that her suffering could not be alleviated. The three-step control system enshrined in the Law and promoted by the Federal Control and Evaluation Commission for Euthanasia appears to have failed at each level. CONCLUSION To evaluate requests for euthanasia for mental suffering caused by psychiatric illness, the requirements of the Belgian Euthanasia Law should be complemented by mandating the advice of two psychiatrists, and face-to-face discussions between all physicians involved. In parallel with the process of evaluating the euthanasia request, a treatment track should be guaranteed where reasonable evidence-based treatments and recovery-oriented options are tried.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Sien Loos
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium.,Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sigrid Sterckx
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Erik Thys
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium.,Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
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12
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Affiliation(s)
- Magenta Simmons
- Orygen, Parkville, Victoria, and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Simmons, Filia); Jo Farmer Consulting, Melbourne, Victoria, Australia (Farmer)
| | - Jo Farmer
- Orygen, Parkville, Victoria, and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Simmons, Filia); Jo Farmer Consulting, Melbourne, Victoria, Australia (Farmer)
| | - Kate Filia
- Orygen, Parkville, Victoria, and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Simmons, Filia); Jo Farmer Consulting, Melbourne, Victoria, Australia (Farmer)
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13
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Thomas EC, Suarez J, Lucksted A, Siminoff LA, Hurford I, Dixon LB, O'Connell M, Penn DL, Salzer MS. Facilitating treatment engagement for early psychosis through peer-delivered decision support: intervention development and protocol for pilot evaluation. Pilot Feasibility Stud 2021; 7:189. [PMID: 34689830 PMCID: PMC8543800 DOI: 10.1186/s40814-021-00927-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Emerging adults with early psychosis demonstrate high rates of service disengagement from critical early intervention services. Decision support interventions and peer support have both been shown to enhance service engagement but are understudied in this population. The purposes of this article are to describe the development of a novel peer-delivered decision coaching intervention for this population and to report plans for a pilot study designed to gather preliminary data about its feasibility, acceptability, and potential impact. METHODS The intervention was developed based on formative qualitative data and in collaboration with a diverse team of researchers, key stakeholders, and expert consultants. The pilot trial will utilize a single-group (N = 20), pre-post, convergent mixed-methods design to explore whether and how the intervention addresses decision-making needs (the primary intervention target). The impact of the intervention on secondary outcomes (e.g., engagement in the program) will also be assessed. Additionally, through observation and feedback from the peer decision coach and study participants, we will evaluate the feasibility of research and intervention procedures, and the acceptability of information and support from the peer decision coach. DISCUSSION The peer-delivered decision coaching intervention holds promise for assisting young people with making informed and values-consistent decisions about their care, and potentially enhancing service engagement within this traditionally difficult-to-engage population. If the intervention demonstrates feasibility and acceptability, and pilot data show its potential for improving treatment decision-making, our work will also lay the foundation for a new evidence base regarding roles for peer specialists on early intervention teams. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034 ) on 28 August 2020 as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis.
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Affiliation(s)
- Elizabeth C Thomas
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA.
| | - John Suarez
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA
| | - Alicia Lucksted
- University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, 21201, USA
| | - Laura A Siminoff
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA
| | - Irene Hurford
- Irene Hurford MD PLLC, 261 Old York Road #925, Jenkintown, PA, 19046, USA
| | - Lisa B Dixon
- Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Maria O'Connell
- Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - David L Penn
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, 256 Davie Hall, Chapel Hill, NC, 27514, USA
- Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia
| | - Mark S Salzer
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA
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14
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Matejkowski J. Challenges to Employing Shared Decision Making With Adults Under Community Supervision Who Have a Mental Illness. Front Psychiatry 2021; 12:773411. [PMID: 34803780 PMCID: PMC8599275 DOI: 10.3389/fpsyt.2021.773411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Adults under community corrections supervision and who have a mental illness (MI) are expected to comply with conditions of release which often include involvement with supportive social services. The rates of technical violation, arrest, and incarceration that result from failure to comply with these mandates are exceedingly high. Shared decision making among officer-supervisors and client-supervisees is a promising approach to promote engagement in community corrections services among supervisees who have MI. This paper reviews recent research on shared decision making and identifies three barriers to its implementation in this context: (1) a lack of role clarity, (2) a predilection for risk avoidance, and (3) stigma toward supervisees. Empirically supported recommendations are suggested to aid in overcoming these obstacles, facilitate shared decision making, and promote recovery among this population: (1) unification of supervisor rehabilitative and public safety roles, (2) maximizing opportunities for self-determination through low-stakes events and/or enhancement of supervisee strengths and capabilities, and (3) supervisor training in principles of mental health recovery.
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Affiliation(s)
- Jason Matejkowski
- School of Social Welfare, University of Kansas, Lawrence, KS, United States
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