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Treichler EBH, McBride LE, Gomez E, Jain J, Seaton S, Yu KE, Oakes D, Perivoliotis D, Girard V, Reznik S, Salyers MP, Thomas ML, Spaulding WD, Granholm EL, Rabin BA, Light GA. Enhancing patient-clinician collaboration during treatment decision-making: study protocol for a community-engaged, mixed method hybrid type 1 trial of collaborative decision skills training (CDST) for veterans with psychosis. Trials 2024; 25:363. [PMID: 38840160 PMCID: PMC11155075 DOI: 10.1186/s13063-024-08127-4] [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: 08/14/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Patient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST's feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST's effectiveness in comparison with an active control and further evaluate implementation feasibility. METHODS The planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation. DISCUSSION If CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally. TRIAL REGISTRATION ClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.
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Affiliation(s)
- Emily B H Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA.
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA.
| | - Lauren E McBride
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
| | - Elissa Gomez
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joanna Jain
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Sydney Seaton
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Kasey E Yu
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - David Oakes
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
- VA San Diego Psychology Service, San Diego, CA, USA
| | | | - Samantha Reznik
- University of Texas at Austin, Texas Institute for Excellence in Mental Health, Austin, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - Eric L Granholm
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
- VA San Diego Psychology Service, San Diego, CA, USA
| | - Borsika A Rabin
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Center of Excellence in Stress and Mental Health, San Diego VA, La Jolla, CA, USA
| | - Gregory A Light
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
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Bufford T, Aralis H, Kataoka S, Lee SJ, Lavelle Trinh C, Lester P. Creating a Statistical Analysis Plan to Continually Evaluate Intervention Adaptations that Arise in Real-World Implementation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1302-1313. [PMID: 37243867 PMCID: PMC10220329 DOI: 10.1007/s11121-023-01513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/29/2023]
Abstract
Evidence-based health interventions are frequently translated into real-world settings where practical needs drive changes to intervention protocols. Due to logistical and resource constraints, these naturally arising adaptations are rarely assessed for comparative effectiveness using a randomized trial. Nevertheless, when observational data are available, it is still possible to identify beneficial adaptations using statistical methods that adjust for differences among intervention groups. As implementation continues and more data are collected and assessed, we also require analysis methods that ensure low statistical error rates as multiple comparisons are made over time. This paper describes how to create a statistical analysis plan for evaluating adaptations to an intervention during ongoing implementation. This can be done by combining methods commonly used in platform clinical trials with methods used for real-world data. We also demonstrate how to use simulations based on previous data to decide the frequency with which to conduct statistical analyses. The illustration uses data from large-scale implementation of a school-based resilience and skill-building preventive intervention to which several adaptations were made. The proposed statistical analysis plan for evaluating the school-based intervention has potential to improve population-level outcomes as implementation scales up further and additional adaptations are anticipated.
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Affiliation(s)
- Teresa Bufford
- Department of Biostatistics, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095, USA.
| | - Hilary Aralis
- Department of Biostatistics, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095, USA
| | - Sheryl Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
| | - Sung-Jae Lee
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
| | - Carla Lavelle Trinh
- Los Angeles Unified School District School Mental Health, 333 South Beaudry Avenue, Los Angeles, CA, 90017, USA
| | - Patricia Lester
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
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Treichler EBH, Reznik SJ, Oakes D, Girard V, Zisman-Ilani Y. Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations. BJPsych Open 2023; 9:e154. [PMID: 37578050 PMCID: PMC10486237 DOI: 10.1192/bjo.2023.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.
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Affiliation(s)
- Emily B. H. Treichler
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA; and Department of Psychiatry, University of California, San Diego, California, USA
| | - Samantha J. Reznik
- VA San Diego Psychosocial Rehabilitation and Recovery Center, San Diego, California, USA; and Texas Institute for Excellence in Mental Health, University of Texas at Austin, Austin, Texas, USA
| | - David Oakes
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA
| | - Vanessa Girard
- VA San Diego Psychosocial Rehabilitation and Recovery Center, VA San Diego, San Diego, California, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA; and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
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Treichler EBH, Mercado R, Oakes D, Perivoliotis D, Gallegos-Rodriguez Y, Sosa E, Cisneros E, Spaulding WD, Granholm E, Light GA, Rabin B. Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers. BMC Health Serv Res 2022; 22:1543. [PMID: 36528579 PMCID: PMC9759039 DOI: 10.1186/s12913-022-08833-2] [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: 07/05/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. METHODS A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes-no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). RESULTS Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. CONCLUSIONS A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations.
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Affiliation(s)
- Emily B. H. Treichler
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Robert Mercado
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - David Oakes
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Dimitri Perivoliotis
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Yuliana Gallegos-Rodriguez
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Elijah Sosa
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Erin Cisneros
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - William D. Spaulding
- grid.24434.350000 0004 1937 0060Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588 USA
| | - Eric Granholm
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Gregory A. Light
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Borsika Rabin
- grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.266100.30000 0001 2107 4242Clinical and Translational Research Center Dissemination and Implementation Science Center, UC San Diego Altman, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
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Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11:CD007297. [PMID: 36367232 PMCID: PMC9650912 DOI: 10.1002/14651858.cd007297.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. OBJECTIVES To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. SEARCH METHODS We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. MAIN RESULTS This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. AUTHORS' CONCLUSIONS This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukari Yaju
- Department of Epidemiology and Biostatistics for Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Leigh Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, The University of Stirling, Scotland, UK
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The Interaction between Basic Psychological Needs, Decision-Making and Life Goals among Emerging Adults in South Africa. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11070316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The interaction between emerging adult psychological well-being and decision-making, in South Africa, has not been explicitly explored in Self-Determination Theory. Life goals have been thought to play a role in the interaction between basic psychological needs and decision-making to promote psychological well-being. The current study, therefore, aimed to examine whether the decision-making styles employed, and the life goals which were deemed important, contribute to the understanding of the satisfaction or frustration of the basic psychological needs of emerging adults in South Africa. Data were collected cross-sectionally, using a secure, online survey among 1411 participants. The interaction between decision-making, life goals and basic psychological needs variables were examined using descriptive statistics, Pearson correlations and hierarchical regression analyses. The results in the study suggest that adaptive (vigilant) decision-making and intrinsic life goals were significant predictors for the satisfaction of the basic psychological needs. Some forms of maladaptive decision-making and extrinsic goals were predictors of the frustration of basic psychological needs. The variance explained by the various models were between 15.6–32.6%, with the results suggesting all models were significant. The results provide a novel contribution to emerging adult well-being in South Africa and Self-Determination Theory, with the implications for society, research and practice discussed.
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