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Francis CJ, Johnson A, Wilson RL. Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers. Health Expect 2024; 27:e14001. [PMID: 38433012 PMCID: PMC10909645 DOI: 10.1111/hex.14001] [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: 08/22/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. OBJECTIVES We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. METHODS Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. RESULTS Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). CONCLUSIONS On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer. PATIENT OR PUBLIC CONTRIBUTION This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.
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Affiliation(s)
| | - Amanda Johnson
- Head of School, Dean of Nursing and MidwiferyUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Rhonda L. Wilson
- University of NewcastleNewcastleNew South WalesAustralia
- Massey UniversityPalmerston NorthNew Zealand
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2
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Yao X, Zhang X. Treatment decision making in psychiatry: Formulating patients’ perspectives in outpatient psychiatric consultations. Front Psychol 2023; 14:1144500. [PMID: 37051608 PMCID: PMC10083260 DOI: 10.3389/fpsyg.2023.1144500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/06/2023] [Indexed: 03/28/2023] Open
Abstract
Seeking and understanding patients’ values and preferences is one of the essential elements in shared decision making, which is associated with treatment adherence in psychiatry. However, negotiating treatment in psychiatric contexts can be challenging with patients whose ability to evaluate treatment recommendations rationally may be impaired. This article attempts to examine a conversational practice that psychiatrists use to deal with patients’ views and perspectives by formulating what the patients have said related to treatment. Taking the naturally occurring, face-to-face outpatient psychiatric consultations as the data, the present study uses conversation analysis (CA) as a method to demonstrate in a fine-grained detail what functions formulations of patients’ perspectives serve in psychiatric contexts. We found that by eliciting patients’ views and perspectives toward treatment, this type of formulation is not only used to achieve mutual understanding and establish the grounds for treatment decisions, but may also be used to challenge the legitimacy of patients’ position, steering treatment decision to the direction preferred by the psychiatrists. We argue that in the process of treatment decision making, psychiatrists do not simply impose their perspectives upon the patients, instead, they attempt to achieve consensus with patients by balancing their institutional authority and orientation to the patients’ perspectives. Data are in Chinese with English translation.
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Affiliation(s)
- Xueli Yao
- School of Foreign Languages, Qingdao Agricultural University, Qingdao, China
| | - Xiaoning Zhang
- Shandong Provincial Medical Association, Jinan, China
- *Correspondence: Xiaoning Zhang,
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3
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Vogel A, Guinemer C, Fürstenau D. Patients' and healthcare professionals' perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review. BMC Health Serv Res 2023; 23:197. [PMID: 36829131 PMCID: PMC9960423 DOI: 10.1186/s12913-023-09120-4] [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: 10/11/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in perioperative care, is an organizational approach to instituting sharing of information and decision-making around surgery. It aims at enabling patient autonomy and patient-centered care. Frail and elderly patients suffering from multiple health conditions and increased surgical vulnerability might particularly benefit from SDM. However, little is known about the facilitators and barriers to implementing SDM in perioperative care for the specific needs of frail and elderly patients. Our objective is twofold: First, we aim at collecting, analyzing, categorizing, and communicating facilitators and barriers. Second, we aim at collecting and mapping conceptual approaches and methods employed in determining and analyzing these facilitators and barriers. METHODS The search strategy focused on peer-reviewed studies. We employed a taxonomy which is based on the SPIDER framework and added the items general article information, stakeholder, barriers/facilitators, category, subcategory, and setting/contextual information. This taxonomy is based on preceding reviews. The scoping review is reported under the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Based on the databases MEDLINE, Embase, CINAHL, and Web of Science, we screened 984 articles, identified, and reviewed 13 original studies. RESULTS Within this review, two primary facilitators concerning patients' willingness to participate in SDM emerged: Patients want to be informed on their medical condition and procedures. Patients prefer sharing decisions with healthcare professionals, compared to decision-making solely by patients or decision-making solely by healthcare professionals. Communication issues and asymmetric power relationships between patients and clinical healthcare professionals are barriers to SDM. Regarding the methodological approaches, the evaluation of the conceptual approaches demonstrates that the selected articles lack employing a distinct theoretical framework. Second, the selected studies mainly used surveys and interviews, observational studies, like ethnographic or video-based studies are absent. CONCLUSION Diverging findings perceived by patients or clinical healthcare professionals were identified. These imply that SDM research related to elderly and frail patients should become more encompassing by employing research that incorporates theory-based qualitative analysis, and observational studies of SDM consultations for understanding practices by patients and clinical healthcare professionals. Observational studies are particularly relevant as these were not conducted. TRIAL REGISTRATION https://osf.io/8fjnb/.
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Affiliation(s)
- Amyn Vogel
- School of Business & Economics, Department of Information Systems, Freie Universität Berlin, Berlin, Germany.
| | - Camille Guinemer
- grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Fürstenau
- grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.32190.390000 0004 0620 5453Department of Business IT, IT University of Copenhagen, Copenhagen, Denmark
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4
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Affiliation(s)
- Joel Sebastian Zugai
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Midwifery and Health Science, University of Notre Dame Australia, Sydney, Australia
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5
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Ramachandran P, Verma SK, Singh SP. Editorial: Psychosocial interventions in psychotic illnesses. Front Psychiatry 2022; 13:1092976. [PMID: 36590625 PMCID: PMC9797287 DOI: 10.3389/fpsyt.2022.1092976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Swapna Kamal Verma
- Institute of Mental Health and Duke NUS Medical School, Singapore, Singapore
| | - Swaran Preet Singh
- Division of Health Sciences, Warwick Medical School, Faculty of Science, Engineering and Medicine, University of Warwick, Coventry, United Kingdom
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6
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Vogel A, Balzer F, Fürstenau D. The social construction of the patient-physician relationship in the clinical encounter: Media frames on shared decision making in Germany. Soc Sci Med 2021; 289:114420. [PMID: 34607053 DOI: 10.1016/j.socscimed.2021.114420] [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: 05/04/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
The literature on healthcare management has noted that shared decision-making (SDM) - a practice of organizing joint decisions between healthcare professionals and patients - should improve healthcare outcomes through patient engagement and autonomy, fostering patient-centeredness. While SDM projects are implemented across Europe and the US, the diffusion of the practice remains partial, and its' conceptualization scattered. Healthcare management literature explores SDM on the underlying assumption that its limited diffusion results from an information problem, implying objective criteria and rational behavior. The purpose of this research is to study the social construction of SDM within the clinical setting and the underlying rationales using the case of one of the largest healthcare markets worldwide - Germany. To capture the complexity of SDM, a frame analysis is conducted on its medial representations. News media is both influential in shaping public opinion, as well as in generating public discourse. This analysis enables one to elaborate different facets of the construct of SDM, to capture inherent patterns of facilitating and obstructing aspects and to explore consequences for the diffusion of SDM. Three facilitating and three obstructive frames on the implementation of SDM were identified. The polarities of these frames range from the questioning of one's decision-making authority to the perception of individual competence and decision-making agency. Moreover, this study reflects on how physicians' and patients' role for SDM is conceived.
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Affiliation(s)
- Amyn Vogel
- Freie Universität Berlin, School of Business & Economics, Department of Information Systems, Germany.
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Digitalization, Copenhagen Business School, Denmark.
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7
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Gurtner C, Schols JMGA, Lohrmann C, Halfens RJG, Hahn S. Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:531-548. [PMID: 33191536 DOI: 10.1111/jpm.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Shared decision-making is a concept originating in the medical field, and it is ideally based on a trustful relationship between the patient and the health professionals involved. Shared decision-making shows potential to strengthen patient autonomy and encourages patients to become involved in decisions regarding their treatment. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: A universal concept and understanding of shared decision-making with relevance specifically to psychiatric clinical practice could not be identified in the analysed literature. Shared decision-making refers to a process, and how and whether the patient wishes to participate in the decision-making process should be clarified from the very beginning. On the basis of this synthesizing review, a process model for psychiatric practice was specified and illustrated to help lead health professionals, patients and other supporters through the decision-making process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The process of shared decision-making should be made visible to all persons involved, and it should be stated at the beginning that a decision must be made. Decisions regarding treatment are usually not limited to a single consultation. A collaborative approach including multiple health professionals and other supporters, such as peer workers and family members, is required. Psychiatric nurses could support patients during the process of decision-making and provide additional information, if requested. ABSTRACT INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision-making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centred and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.
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Affiliation(s)
- Caroline Gurtner
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine & Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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8
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Fekete OR, Langeland E, Larsen TMB, Davidson L, Kinn LG. Recovery at the Clubhouse: challenge, responsibility and growing into a role. Int J Qual Stud Health Well-being 2021; 16:1938957. [PMID: 34126865 PMCID: PMC8208115 DOI: 10.1080/17482631.2021.1938957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To explore how people with mental illness experience recovery in the Clubhouse context, and which ingredients of the model they find active in promoting recovery. Methods: Hermeneutic–phenomenological design. Individual, semi-structured interviews with 18 Norwegian Clubhouse members. Systematic text condensation was used in analysis. Results: Three main themes emerged: “Balancing unlimited support with meeting challenges”, with two sub-themes: “Unlimited membership: space for self-agency or hindering development?” and “Becoming a Clubhouse member: concerns and positive experiences”. The second main theme was: “Learning how to build new skills and roles in the community”. The third main theme was: “Getting better through and for work”, with two sub-themes: “Work at the Clubhouse as a means to recovery” and “Preparing for a working life in society”. Overall, participants experienced improved mental and social wellbeing and work readiness. Conclusions: Recovery in the Clubhouse context requires members’ personal initiative, thus people having poor mental health might struggle with utilizing the Clubhouse. However, participants reported that lack of challenges within the community thwarted their recovery. Based on Salutogenesis, conscious application of challenge in Clubhouse activities might enhance members’ recovery. Furthermore, participants’ all-round involvement in their recovery journeys suggests the importance of shared decision-making in recovery-oriented services.
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Affiliation(s)
- Orsolya Reka Fekete
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Eva Langeland
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Torill M B Larsen
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Larry Davidson
- Yale Program for Recovery and Community Health, Yale University, New Haven, CT, USA
| | - Liv Grethe Kinn
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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9
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Aoki Y. Shared decision making for adults with severe mental illness: A concept analysis. Jpn J Nurs Sci 2020; 17:e12365. [PMID: 32761783 PMCID: PMC7590107 DOI: 10.1111/jjns.12365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 06/27/2020] [Indexed: 12/01/2022]
Abstract
AIM Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. METHODS Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. RESULTS Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship. CONCLUSIONS Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
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Affiliation(s)
- Yumi Aoki
- Psychiatric & Mental Health Nursing, Graduate School of NursingSt. Luke's International UniversityTokyoJapan
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10
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Rioli G, Ferrari S, Henderson C, Vandelli R, Galli G, Minarini A, Galeazzi GM. Users' choice and change of allocated primary mental health professional in community-based mental health services: A scoping review. Int J Soc Psychiatry 2020; 66:373-381. [PMID: 32126868 DOI: 10.1177/0020764020910182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The recovery model in mental health care emphasizes users' right to be involved in key decisions of their care, including choice of one's primary mental health professional (PMHP). AIMS The aim of this article was to provide a scoping review of the literature on the topic of users' choice, request of change and preferences for the PMHP in community mental health services. METHOD A search of the PubMed, Cochrane Library, Web of Science and PsycINFO for papers in English was performed. Additional relevant research articles were identified through the authors' personal bibliography. RESULTS A total of 2,774 articles were screened and 38 papers were finally included. Four main aspects emerged: (1) the importance, for users, to be involved in the choice of their PMHP; (2) the importance, for users, of the continuity of care in the relationship with their PMHP; (3) factors of the user/PMHP dyad influencing users' preferences; and (4) the effect of choice on the treatment outcomes. CONCLUSION While it is generally agreed that it is important to consider users' preferences in choosing or requesting to change their PMHP, little research on this topic is available. PMHPs' and other stakeholders' views should also be explored in order to discuss ethical and practical issues.
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Affiliation(s)
- Giulia Rioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Claire Henderson
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Riccardo Vandelli
- School of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Galli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Minarini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
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11
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Christiansen R, Emiliussen J. Manipulation and free will in shared decision making. J Eval Clin Pract 2020; 26:403-408. [PMID: 31529578 DOI: 10.1111/jep.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
In recent years, there has been an increased focus on patient involvement in treatment planning in the health care system. To reduce the risk of the clinician moving towards paternalism, various methods have been introduced-shared decision making, among others. The goal of shared decision making is for the clinician and patient to share available evidence on the best treatment and to raise awareness on the needs and preferences of the patient as to make a genuinely informed choice. However, in the present article, we discuss to which degree paternalism can be avoided in light of the clinician's role as an authority with certain knowledge and expertise. Through the philosophical theory of reasons-responsiveness, we discuss to which extend free will and control applies to the patient. Through theoretical analysis, we come to suggest that the clinician has a role as an ally rather than manipulator.
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Affiliation(s)
- Regina Christiansen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark.,Unit for Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Emiliussen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark.,Unit for Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
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12
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Kalsi D, Ward J, Lee R, Fulford K, Handa A. Shared decision-making across the specialties: Much potential but many challenges. J Eval Clin Pract 2019; 25:1050-1054. [PMID: 31502393 DOI: 10.1111/jep.13276] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/28/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023]
Abstract
Shared decision-making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed-upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. The specialties we consider are Primary Care, Mental Health, Paediatrics, Palliative Care, Medicine, and Surgery. SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high-quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient-centred care but must be implemented with continued people centricity in order to realize its full potential.
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Affiliation(s)
- Dilraj Kalsi
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Joel Ward
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Regent Lee
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
| | - Kenneth Fulford
- Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
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13
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Patient-Centered Values and Experiences with Emergency Department and Mental Health Crisis Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:611-622. [PMID: 29383464 DOI: 10.1007/s10488-018-0849-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Little is known about what patients value in psychiatric crisis services or how they compare community-based services with those received in the emergency department. Three focus groups (n = 27) were held of participants who had received psychiatric crisis services in emergency departments or a community mental health center. Participants described care experiences and preferences. Focus groups were audio recorded, transcribed, and coded using a value-based lens. Themes included appreciation for feeling respected, basic comforts, and shared decision-making as foundations of quality care. Participants preferred the community mental health center. Research should address long-term outcomes to motivate change in psychiatric crisis care.
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14
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Bolden GB, Angell B, Hepburn A. How clients solicit medication changes in psychiatry. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:411-426. [PMID: 30671991 PMCID: PMC6359956 DOI: 10.1111/1467-9566.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In psychiatry, practitioners are encouraged to adopt a patient-centred approach that emphasises shared decision-making. In this article, we investigate how clients with severe mental illnesses (e.g. schizophrenia) advocate for their treatment preferences in psychiatric consultations. The study uses Conversation Analysis to examine audio-recorded medication check appointments in a comprehensive treatment programme known as assertive community treatment (ACT). The analysis shows that clients solicit medication changes at activity boundaries and design them in one of the following ways: reporting a physical problem; reporting a medication problem; explicitly requesting a medication change; and demanding a change. These formats put pressure on the psychiatrist to respond by either offering a solution to the client's problem or by accepting or rejecting the client's request. Through a detailed analysis of clients' communicative behaviours, we show that, in soliciting a medication change, clients ordinarily respect boundaries of medical authority and present themselves as 'good' patients who are reliable witnesses of their own experiences. Overall, the paper advances our understanding of patient advocacy in psychiatry and mental health interactions more generally.
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Affiliation(s)
- Galina B Bolden
- Department of Communication, Rutgers University, Camden, New Jersey, USA
| | - Beth Angell
- Virginia Commonwealth University, Richmond, VA, USA
| | - Alexa Hepburn
- Department of Communication, Rutgers University, Camden, New Jersey, USA
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15
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Bonfils KA, Dreison KC, Luther L, Fukui S, Dempsey AE, Rapp CA, Salyers MP. Implementing CommonGround in a community mental health center: Lessons in a computerized decision support system. Psychiatr Rehabil J 2018; 41:216-223. [PMID: 27732033 PMCID: PMC5386823 DOI: 10.1037/prj0000225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although shared decision making (SDM) is a key element of client-centered care, it has not been widely adopted. Accordingly, interventions have been developed to promote SDM. The aim of this study was to explore the implementation process of one SDM intervention, CommonGround, which utilizes peer specialists and a computerized decision support center to promote SDM. METHOD As part of a larger study, CommonGround was implemented in 4 treatment teams in a community mental health center. The implementation process was examined by conducting semistructured interviews with 12 staff members that were integral to the CommonGround implementation. Responses were analyzed using content analysis. Program fidelity and client program use were also examined. RESULTS Although key informants identified several client and staff benefits to using CommonGround, including improved treatment engagement and availability of peer specialists, most clients did not use CommonGround consistently throughout the implementation. Key informants and fidelity reports indicated a number of program (e.g., technological difficulties, increased staff burden) and contextual barriers (e.g., poor fit with service structure, decision support center location, low staff investment and high turnover) to the successful implementation of CommonGround. Strategies to maximize the implementation by increasing awareness, buy-in, and utilization are also reported. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This implementation of CommonGround was limited in its success partly as a result of program and contextual barriers. Future implementations may benefit from incorporating the strategies identified to maximize implementation in order to obtain the full program benefits. (PsycINFO Database Record
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Affiliation(s)
- Kelsey A Bonfils
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Kimberly C Dreison
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Sadaaki Fukui
- School of Social Welfare Center for Mental Health Research and Innovation, University of Kansas
| | - Abigail E Dempsey
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Charles A Rapp
- School of Social Welfare Center for Mental Health Research and Innovation, University of Kansas
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis
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Jones A, Hannigan B, Coffey M, Simpson A. Traditions of research in community mental health care planning and care coordination: A systematic meta-narrative review of the literature. PLoS One 2018; 13:e0198427. [PMID: 29933365 PMCID: PMC6014652 DOI: 10.1371/journal.pone.0198427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
CONTEXT In response to political and social factors over the last sixty years mental health systems internationally have endeavoured to transfer the delivery of care from hospitals into community settings. As a result, there has been increased emphasis on the need for better quality care planning and care coordination between hospital services, community services and patients and their informal carers. The aim of this systematic review of international research is to explore which interventions have proved more or less effective in promoting personalized, recovery oriented care planning and coordination for community mental health service users. METHODS A systematic meta-narrative review of research from 1990 to the present was undertaken. From an initial return of 3940 papers a total of 50 research articles fulfilled the inclusion criteria, including research from the UK, Australia and the USA. FINDINGS Three research traditions are identified consisting of (a) research that evaluates the effects of government policies on the organization, management and delivery of services; (b) evaluations of attempts to improve organizational and service delivery efficiency; (c) service-users and carers experiences of community mental health care coordination and planning and their involvement in research. The review found no seminal papers in terms of high citation rates, or papers that were consistently cited over time. The traditions of research in this topic area have formed reactively in response to frequent and often unpredictable policy changes, rather than proactively as a result of intrinsic academic or intellectual activity. This may explain the absence of seminal literature within the subject field. As a result, the research tradition within this specific area of mental health service delivery has a relatively short history, with no one dominant researcher or researchers, tradition or seminal studies amongst or across the three traditions identified. CONCLUSIONS The research findings reviewed suggests a gap has existed internationally over several decades between policy aspirations and service level interventions aimed at improving personalised care planning and coordination and the realities of everyday practices and experiences of service users and carers. Substantial barriers to involvement are created through poor information exchange and insufficient opportunities for care negotiation.
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Affiliation(s)
- Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Michael Coffey
- Department of Public Health Policy and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City University London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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Measuring Neurobehavioral Functioning in People With Traumatic Brain Injury: Rasch Analysis of Neurobehavioral Functioning Inventory. J Head Trauma Rehabil 2018; 31:E59-68. [PMID: 26394297 PMCID: PMC4949000 DOI: 10.1097/htr.0000000000000170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine internal construct validity of the Neurobehavioral Functioning Inventory (NFI) by applying Rasch analysis. SETTING An outpatient rehabilitation program trial in New Zealand employing a goal-setting intervention in people with traumatic brain injury (TBI). PARTICIPANTS One hundred eight people (mean age = 46 years; 73% male) between 6 months and 5 years post-TBI. DESIGN Rasch analysis of the NFI (Partial Credit Model). RESULTS Three NFI subscales were not unidimensional and at least 4 items in each subscale had disordered response categories. Two items showed differential item functioning by age, 1 item by educational attainment, and 2 items were found to misfit the overall construct. These items were excluded from the total score calculation. The revised scale fit the Rasch model and supported the internal construct validity of the NFI. CONCLUSIONS Current scoring of the NFI subscales for people with TBI in New Zealand does not meet the requirements of the Rasch model. The revised version of NFI can improve the interpretation of scores but should be further tested with people with TBI in other settings.
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Brooks H, Harris K, Bee P, Lovell K, Rogers A, Drake R. Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views of service users, carers and professionals. Int J Ment Health Syst 2017; 11:42. [PMID: 28670338 PMCID: PMC5490161 DOI: 10.1186/s13033-017-0149-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/12/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As a response to evidence that mental health service users and carers expect greater involvement in decisions about antipsychotic medication choice and prescribing, shared decision-making (SDM) has increasingly come to be viewed as an essential element of person-centred care and practice. However, this aspiration has yet to be realised in practice, as service users and carers continue to feel alienated from healthcare services. Existing understanding of the factors affecting the use of tools to support SDM is limited to inter-individual influences and wider factors affecting potential implementation are underexplored. AIM To explore the potential use of a tool designed to enhance collaborative antipsychotic prescribing from the perspectives of secondary care mental health service users, carers and professionals. METHODS We conducted a qualitative study (semi-structured interviews and focus groups) using a convenience sample of 33 participants (10 mental health service users, 10 carers and 13 professionals) involved in antipsychotic prescribing in one Trust in the North of England. Participants were asked about the potential implementation of a tool to support SDM within secondary mental health services. Framework analysis incorporating the use of constant comparative method was used to analyse the data. RESULTS The study identified a divergence in the views of service users and professionals, including a previously undocumented tendency for stakeholder groups to blame each other for potential implementation failure. This dissonance was shaped by meso and macro level influences relating to paternalism, legislative frameworks, accountability and lack of resources. Participants did not identify any macro level (policy or structural) facilitators to the use of the tool highlighting the negative impact of mental health contexts. Our study indicated that inter-individual factors are likely to be most important to implementation, given their potential to transcend meso and macro level barriers. CONCLUSIONS Consideration of the meso and macro level influences identified areas for potential intervention, including challenging professionals' and service users' perceptions of each other, rebalancing the notion of accountability within services and introducing new means for service user feedback on the quality of SDM. Multi-level strategies for facilitating the implementation of tools to support SDM are also presented.
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Affiliation(s)
- Helen Brooks
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Penny Bee
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
| | - Karina Lovell
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Richard Drake
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
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An SY, Kim GH, Kim JY. Effectiveness of Shared Decision-Making Training Program in People With Schizophrenia in South Korea. Perspect Psychiatr Care 2017; 53:111-118. [PMID: 26601913 DOI: 10.1111/ppc.12144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the effects of shared decision-making (SDM) training program on self-esteem, problem-solving ability, and quality of life in people with schizophrenia. DESIGN AND METHODS A quasi-experiment with a nonequivalent control group pre-posttest design was conducted. The self-esteem scale, the problem-solving ability scale, and the WHOQOL Scale were used. FINDINGS The SDM training program was effective in improving their self-esteem, problem-solving ability, and quality of life in people with schizophrenia. PRACTICE IMPLICATIONS The SDM training program can be used in various mental health fields such as hospitals, mental health centers, and rehabilitation facilities.
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Affiliation(s)
- Se Youn An
- Yong-in Mental Hospital, Yongin-si, GyongGi-do, Korea
| | | | - Ji Young Kim
- College of Nursing, Chonbuk Research Institute of Nursing Science, Chonbuk National University, Jeonju-si, Jeollabuk-do, Korea
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20
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Choy-Brown M, Padgett D, Smith B, Tiderington E. Sorting it out: Eliciting consumer priorities for recovery in supportive housing. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2017; 19:223-234. [PMID: 28239306 DOI: 10.1080/15487768.2016.1197862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to understand participant priorities in their personal recovery journey and their perspectives of recovery domains. METHODS A card sort data gathering technique was employed to elicit priorities in recovery from consumers in supportive housing programs serving formerly homeless adults with severe mental illnesses in New York City. Participants (N=38) were asked to sort 12 cards printed with recovery domains in order of importance and describe the meaning attached to each domain. RESULTS Mental health (95%), physical health (89%), and housing (92%) were the domains most frequently included and prioritized in the top three rankings. Family (76%) and partner (74%) were also frequently included and endorsed as most important second only to mental health. Housing was prioritized yet rated most important less often (58%). Work, school, hobbies, program, friends and neighborhood were less frequently endorsed. 'Card sort talk' revealed critical understanding of participants' priorities and their reasons for endorsing other domains less frequently. CONCLUSIONS Most important to participants was regaining functional independence through improved mental and physical health and access to housing. With underlying principles of efficiency and empowerment, card sort is a promising engagement technique for providers to elicit consumer priorities in their own recovery.
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Affiliation(s)
- Mimi Choy-Brown
- New York University, Silver School of Social Work, 20 Cooper Square, New York, 10003 United States
| | | | - Bikki Smith
- New York University, New York, United States
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Díaz-Castro L, Arredondo A, Pelcastre-Villafuerte BE, Hufty M. Governance and mental health: contributions for public policy approach. Rev Saude Publica 2017; 51:4. [PMID: 28146159 PMCID: PMC5286910 DOI: 10.1590/s1518-8787.2017051006991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/19/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the conceptualization of the term governance on public mental health programs. METHODS In this systematic review, we analyzed the scientific literature published in the international scenario during 15 years (from 2000 to 2015). The databases analyzed were: Medline, CINAHL, PsycINFO and PubMed. Governance and mental health were the descriptors. We included relevant articles according to our subject of study and levels of analysis: (i) the concept of governance in mental health; (ii) process and decision spaces; (iii) strategic and pertinent actors who operate in the functioning of the health system, and (iv) social regulations. We excluded letters to the editor, news articles, comments and case reports, incomplete articles and articles whose approach did not include the object of study of this review. RESULTS We have found five conceptualizations of the term governance on mental health in the area of provision policies and service organization. The agents were both those who offer and those who receive the services: we identified several social norms. CONCLUSIONS The concept of governance in mental health includes standards of quality and attention centered on the patient, and incorporates the consumers of mental healthcare in the decision-making process. OBJETIVO Analizar la conceptualización del término gobernanza en las políticas de salud mental. MÉTODOS En esta revisión sistemática se analizó literatura científica publicada en el ámbito internacional durante 15 años (de 2000 hasta 2015). Las bases de datos analizadas fueron: Medline, CINAHL, PsycINFO y PubMed. Los descriptores fueron gobernanza y salud mental. Fueron incluidos artículos relevantes de acuerdo a nuestro objeto de estudio y niveles de análisis: (i) concepto de gobernanza en salud mental; (ii) proceso y espacios de decisión; (iii) actores estratégicos y de interés que intervienen en el funcionamiento del sistema de salud, y (iv) normas sociales. Se excluyeron cartas al editor, noticias, comentarios y reporte de caso, artículos incompletos y artículos que no incluyeran en su abordaje el objeto de estudio de esta revisión. RESULTADOS Se reportaron cinco conceptualizaciones del término gobernanza en salud mental en el ámbito de políticas de provisión y organización de servicios. Los actores fueron desde proveedores a usuarios de servicios; se identificaron diversas normas sociales. CONCLUSIONES El concepto de gobernanza en salud mental incorpora estándares de calidad y atención centrada en el paciente, e incluye a los usuarios en la toma de decisiones.
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Affiliation(s)
- Lina Díaz-Castro
- Servicios de Atención Psiquiátrica. Secretaría de Salud. Ciudad de México, México
| | | | | | - Marc Hufty
- Graduate Institute of International and Development Studies. Geneva, Switzerland
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Grundy AC, Bee P, Meade O, Callaghan P, Beatty S, Olleveant N, Lovell K. Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives. J Psychiatr Ment Health Nurs 2016; 23:12-21. [PMID: 26634415 DOI: 10.1111/jpm.12275] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited. QUESTION How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process? METHODS In 2013, we conducted five focus groups (n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services (n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse. DISCUSSION The process of care planning, centred on the user-clinician relationship, is key to user involvement. IMPLICATIONS FOR PRACTICE Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services.
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Affiliation(s)
- A C Grundy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - P Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - O Meade
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - P Callaghan
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - S Beatty
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - N Olleveant
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - K Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Hopmans W, Damman OC, Senan S, Hartemink KJ, Smit EF, Timmermans DRM. A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study. BMC Cancer 2015; 15:959. [PMID: 26673216 PMCID: PMC4682255 DOI: 10.1186/s12885-015-1974-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Background Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM. Methods A sequential mixed methods design was used, consisting of qualitative interviews (N = 11), as well as a survey study (N = 76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed. Results We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) ‘guidance by clinician’ (α = .741), (2) ‘conduct of clinician’ (α = .774); (3) ‘preparation for treatment decision making’ (α = .864); and (4) ‘active role of patient in treatment decision making’ (α = .782). Of these, clinician guidance was rated as most important by patients (M = 3.61; SD = .44). Only 28.9 % of patients in the survey study reported that both treatment options were discussed with them. Conclusions Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Dahlqvist Jönsson P, Schön UK, Rosenberg D, Sandlund M, Svedberg P. Service users' experiences of participation in decision making in mental health services. J Psychiatr Ment Health Nurs 2015; 22:688-97. [PMID: 26148016 DOI: 10.1111/jpm.12246] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/27/2022]
Abstract
ACCESSIBLE SUMMARY Despite the potential positive impact of shared decision making on service users knowledge and experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. This study highlights the desire of users to participate more actively in decision making and demonstrates that persons with SMI struggle to be seen as competent and equal partners in decision-making situations. Those interviewed did not feel that their strengths, abilities and needs were being recognized, which resulted in a feeling of being omitted from involvement in decision-making situations. The service users describe some essential conditions that could work to promote participation in decision making. These included having personal support, having access to knowledge, being involved in a dialogue and clarity about responsibilities. Mental health nurses can play an essential role for developing and implementing shared decision making as a tool to promote recovery-oriented mental health services. ABSTRACT Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.
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Affiliation(s)
- P Dahlqvist Jönsson
- Department of Research, Development and Education (FoUU), Region of Halland, Sweden.,School of Health and Welfare, Halmstad University, Sweden
| | - U-K Schön
- School of Health and Social Work, Dalarna University, Sweden
| | - D Rosenberg
- Department of Social Work, Umeå University, Sweden
| | - M Sandlund
- Department of Social Work, Umeå University, Sweden.,Department of Clinical Science, Umeå University, Sweden
| | - P Svedberg
- School of Health and Welfare, Halmstad University, Sweden
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Bee P, Price O, Baker J, Lovell K. Systematic synthesis of barriers and facilitators to service user-led care planning. Br J Psychiatry 2015; 207:104-14. [PMID: 26243762 PMCID: PMC4523927 DOI: 10.1192/bjp.bp.114.152447] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. AIMS To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. METHOD Systematic evidence synthesis. RESULTS Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. CONCLUSIONS Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.
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Affiliation(s)
- Penny Bee
- Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Angell B, Bolden GB. Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations. Soc Sci Med 2015; 138:44-56. [PMID: 26046726 PMCID: PMC4595152 DOI: 10.1016/j.socscimed.2015.04.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship.
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Affiliation(s)
- Beth Angell
- School of Social Work and the Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, United States.
| | - Galina B Bolden
- School of Communication and Information, Rutgers, the State University of New Jersey, United States
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Should Supported Decision-Making Replace Substituted Decision-Making? The Convention on the Rights of Persons with Disabilities and Coercive Treatment under Queensland’s Mental Health Act 2000. LAWS 2015. [DOI: 10.3390/laws4020173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Eliacin J, Salyers MP, Kukla M, Matthias MS. Patients' understanding of shared decision making in a mental health setting. QUALITATIVE HEALTH RESEARCH 2015; 25:668-678. [PMID: 25246333 DOI: 10.1177/1049732314551060] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients' perspectives. We examined patients' accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients' understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient-provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient-provider relationship as a fundamental element of shared decision making and point to areas for potential improvement.
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Affiliation(s)
- Johanne Eliacin
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Marina Kukla
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Marianne S Matthias
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA Regenstrief Institute, Indianapolis, Indiana, USA
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Fukui S, Matthias MS, Salyers MP. Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:40-6. [PMID: 24500023 PMCID: PMC4125549 DOI: 10.1007/s10488-014-0539-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.
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Affiliation(s)
- Sadaaki Fukui
- The University of Kansas School of Social, Welfare Center for Mental Health Research and Innovation, 1545 Lilac Lane Lawrence, KS 66044, U.S. A TEL: (785)864-5874; FAX: (785)864-5277;
| | - Marianne S. Matthias
- Roudebush VA Medical Center and Regenstrief Institute, Adjunct Assistant Professor, Department of Communication Studies, Indiana University-Purdue University Indianapolis, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-4514; FAX: (317)988-5361;
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis; Co-Director, ACT Center of Indiana, 402 N. Blackford Street, LD 124, Indianapolis, IN 46202, TEL: (317) 274-2904
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Gioia D, Autrey S, Drapalski AL, Glynn S, Cohen AN, Dixon LB. Veterans' Views of a Shared Decision-Making Process: A Qualitative Substudy of REORDER. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2014. [DOI: 10.1080/15487768.2014.903877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kemp V, Fisher C, Lawn S, Battersby M, Isaac MK. Small steps: barriers and facilitators to physical health self-management by people living with mental illness. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2014. [DOI: 10.1080/14623730.2014.931069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fukui S, Salyers MP, Matthias MS, Collins L, Thompson J, Coffman M, Torrey WC. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community Ment Health J 2014; 50:375-82. [PMID: 23299226 PMCID: PMC3980460 DOI: 10.1007/s10597-012-9584-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock's Informed Decision Making Scale (Braddock et al. 1997, 1999, 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was "exploration of consumer preference," with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.
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Affiliation(s)
- Sadaaki Fukui
- The University of Kansas Center for Research Methods and Data Analysis & School of Social Welfare Office of Mental Health Research and Training, Research Associate, 1545 Lilac Lane Lawrence, KS 66044, U.S. A, TEL: (785)864-5874; FAX: (785)864-5277;
| | - Michelle P. Salyers
- Indiana University-Purdue University Indianapolis School of Science Department of Psychology, Associate Professor, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-4419; FAX:(317)988-2719;
| | - Marianne S. Matthias
- Research Scientist, Roudebush VA Medical Center and Regenstrief Institute Adjunct Assistant Professor, Department of Communication Studies, Indiana University-Purdue University Indianapolis, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-4514; FAX: (317)988-2719;
| | - Linda Collins
- Indiana University-Purdue University Indianapolis School of Science Department of Psychology, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-2722; FAX: (317)988-2719;
| | - John Thompson
- University of Kansas School of Social Welfare Office of Mental Health Research and Training, Graduate Research Assistant, 1545 Lilac Lane, Lawrence, KS 66044, TEL:(785)864-4720; FAX: (785)864-5277;
| | - Melinda Coffman
- University of Kansas School of Social Welfare Office of Mental Health Research and Training, Research Assistant, 1545 Lilac Lane, Lawrence, KS 66044, TEL:(785)864-5868; FAX:(785)864-5277;
| | - William C. Torrey
- Dartmouth Medical School Dartmouth-Hitchcock Medical Center Department of Psychiatry, Associate Professor & Vice Chair for Clinical Services, One Medical Center Drive, Lebanon, NH 03756, TEL:(603)650-6069; FAX:(603)650-5842;
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Mestdagh A, Hansen B. Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies. Soc Psychiatry Psychiatr Epidemiol 2014; 49:79-87. [PMID: 23835576 DOI: 10.1007/s00127-013-0729-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 06/14/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this review is to identify consistent themes among the qualitative literature on stigma as experienced by patients with schizophrenia receiving community mental health care. With the treatment focus of schizophrenia nowadays shifting more and more towards community-based mental health care, professionals need to be aware of the increased vulnerability of their clients in their social environment as a result of stigma towards their disease. In-depth knowledge on stigma is critical in order to offer a dignifying community mental health care. METHODS A systematic search of the qualitative literature in Web of Science, PubMed, PsycINFO and Francis was performed to review the subjective experiences and ideas on stigma in outpatients with schizophrenia. RESULTS Three major themes were identified in 18 studies and need to be taken into consideration when implementing an adequate community mental health care: (i) the continuing existence of stigma inherent in the health care setting, (ii) the importance of relational aspects of stigma encounters in daily life and (iii) the significance of the behavioural aspects related to previous stigma experiences and beliefs among patients. CONCLUSIONS Despite much effort in community treatment, patients still experience stigma and discrimination. Community mental health care professionals should not only be aware of structural problems in mental health care, but should also pay considerable attention towards the relational and behavioural aspects in their clients' life concerning stigma. Furthermore, they have the crucial role in the community to raise awareness about stigma in order to increase their clients' acceptance in society.
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Affiliation(s)
- Annelien Mestdagh
- Faculty of Medicine, LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium,
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Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centred participation in healthcare. Nurs Ethics 2013; 21:129-47. [DOI: 10.1177/0969733013490593] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article was to critically analyse the concept of person-centred participation in healthcare from patients’ perspectives through a review of qualitative research findings. In accordance with the integrative review method of Broom, data were retrieved from databases, but 60 studies were finally included in the study. The diverse attributes of person-centred participation in healthcare were identified and contrasted with participation that was not person-centred and analysed through framework analysis. Person-centred participation in healthcare was found to be based on patients’ experiences, values, preferences and needs in which respect and equality were central. It manifested itself via three intertwined phases: the human-connection phase, the phase of information processing and the action phase. The results challenge in many aspects earlier concept analyses of patient participation in addition to illuminating patient participation that is not positively valued by patients.
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Peterson KJ. Shared decision making in health care settings: a role for social work. SOCIAL WORK IN HEALTH CARE 2012; 51:894-908. [PMID: 23151285 DOI: 10.1080/00981389.2012.714448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Shared decision making (SDM) is a process integral to social work practice, one where the provider/professional and the consumer/patient discuss treatment alternatives based on patient values and life circumstances and make a shared decision about whether and how to proceed with treatment. Evidence-based medicine suggests that for many health conditions, having the choice of several effective treatment options is not uncommon. In these cases treatment should be based on what is best for the individual, since many factors influence an individual's treatment preference, including the psychological, social, cultural, and spiritual history she/he brings to the medical encounter; a history that has long been ignored in somatic health care. This article develops the argument that medical social workers possess the professional knowledge and skill base to provide decisional coaching, and implementing SDM in primary care settings. Of particular importance are the values that guide professional social work practice, including client self-determination, which is the basis of SDM, and the ability to maintain neutrality.
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Affiliation(s)
- K Jean Peterson
- School of Social Welfare, University of Kansas, Lawrence, KS 66044, USA.
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Abstract
OBJECTIVE Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in making decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. METHODS Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. RESULTS Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers' preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, Internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers' recovery.
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Abstract
PURPOSE OF REVIEW Medical care for chronic conditions imposes a substantial burden on healthcare systems designed originally for acute illness or injury. The notion of chronic disease self-management (CDSM) has been developed as a means of encouraging individuals with chronic conditions to self-manage their own health. It is known that successful chronic disease management reduces hospital admission rates and improves patients' quality of life. Although recognized widely by other medical disciplines, it is beginning to have an impact on psychiatric practice; therefore, a review of how the CDSM approach is implemented in psychiatry is timely. RECENT FINDINGS The move toward self-management in general medicine can be seen by and large as a holistic approach that encourages the person to work in partnership with health professionals to improve outcomes and assist patients to better manage their healthcare needs. One of the defining features of CDSM approaches is the active collaboration between the patient and the healthcare professional. Five mechanisms that demonstrate such active collaboration are self-directed care, illness management and recovery, shared decision-making, joint crisis planning and wellness planning. Their use in psychiatry is discussed. SUMMARY The key feature of CDSM approaches is an active collaboration between healthcare professionals and healthcare consumers. It is a fundamental shift away from traditional active expert/passive patient treatment modes. Each of the five approaches discussed exemplifies the active participation in treatment planning by both consumers and mental health professionals.
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