Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views.

Emma Kaminskiy,Shulamit Ramon,Yaara Zisman-Ilani,Nicola Morant

doi:10.3389/fpsyt.2021.678005

Emma Kaminskiy, Shulamit Ramon + Show 2 more

Open Access

https://doi.org/10.3389/fpsyt.2021.678005

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Abstract

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.

Highlights

Psychiatric medications are often considered to be the cornerstone of psychiatric care [1, 2]
The findings suggest that future interventions to promote Shared decision making (SDM) in practice need to take a multi-faceted approach, including a focus on changing attitudes amongst mental health practitioners, and empowering service users [12]
The findings suggest that the role of the community psychiatric nurse (CPN) for collaborative psychiatric medication management practices may be important

Summary

Introduction

Psychiatric medications are often considered to be the cornerstone of psychiatric care [1, 2]. Inconsistent use of psychiatric medications is associated with mental health services disengagement, frequent emergency department visits, hospitalizations, and more-severe symptoms over time [3, 7]. Shared decision making (SDM) is a recommended healthcare communication practice, with the potential to improve treatment decisions and health outcomes [8, 9]. SDM can promote the person’s involvement in their care, services engagement and treatment adherence [8, 10]. SDM can lead to reduction in stigma and increased involvement [15] and recovery outcomes, such as improved quality of life and symptom severity [16] and patient autonomy [17]

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