Abstract
BackgroundPeople with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics.MethodsA diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation.ResultsAn EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents.ConclusionsThe EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.
Highlights
People with psychosis struggle with decisions about their use of antipsychotics
Existing studies suggest that the use of a shared decision making (SDM) process in psychiatric medication consultations is preferred for making mental health care decisions characterized by uncertainty and when more than one reasonable option is available [22]
Encounter decision aid development We chose a specific format for the Encounter Decision Aid (EDA), the Option Grid decision aid for clinical encounters, that is short and that can be implemented in routine care during medical encounters [45]
Summary
People with psychosis struggle with decisions about their use of antipsychotics They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics. Existing studies suggest that the use of a shared decision making (SDM) process in psychiatric medication consultations is preferred for making mental health care decisions characterized by uncertainty and when more than one reasonable option is available [22]. A recent review by the Australian National Mental Health Consumer Carer Forum on the topic of psychiatric medications concluded, among other things, that a SDM approach encourages the empowered use of psychiatric medications as part of the recovery process and positions patients as active agents in their own recovery process [23]
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