Abstract
WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.
Highlights
Shared decision‐making (SDM) is a process where the carers and the patients in care are engaged in a dialogue of information, aimed at understanding each other's values and preferences regarding care and agreeing on a plan of action (Makoul & Clayman, 2006)
The research question was: What is the meaning of shared decision‐making in mental care? Method: A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in‐depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals
This study aimed at interpreting the meaning of SDM in mental care as perceived by patients and mental health‐ care professionals (MHCPs) and the research question was what is the meaning of SDM in mental care? Patients' and MHCPs' joint perspectives revealed the overall theme being in a space of shar‐ ing decision‐making for dignified mental care
Summary
Shared decision‐making (SDM) is a process where the carers and the patients in care are engaged in a dialogue of information, aimed at understanding each other's values and preferences regarding care and agreeing on a plan of action (Makoul & Clayman, 2006). People with mental ill‐health become patients because they need help to master their life and they are dependent on their MHCPs (Delmar, 2012; Grimen, 2009). MHCPs have been criti‐ cized for playing a dominant role in care which may cause unwanted consequences. This critique stresses the importance of being aware of the patients' own understandings of health and ill‐health, which are significant for the healthcare process (Ocloo & Fulop, 2011). Too much focus on the patients' independence, responsibility and own choice may cause a feeling of devaluation and hinder the patients getting the help needed (Delmar, 2012). Shared decision‐making is possible when the patients' and the MHCPs' shared expertise is applied throughout the mental care (Beyene, Severinsson, Hansen and Rørtveit, 2018b)
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