Mental health professionals\u2019 perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review

Elizabeth Tuudah,Alan Simpson,Sally Barlow,Nafiso Ahmed,Nicholas Drey,Lisa Reynolds,Fareha Begum

doi:10.1186/s12888-021-03304-0

Abstract

BackgroundRisk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO: CRD42016050457) aimed to explore the perceived barriers and enablers to implementing shared decision-making in risk assessment and risk management from mental health professionals’ perspectives.MethodsPRISMA guidelines were followed in the conduct and reporting of this review. Medline, CINAHL, EMBASE, PsycINFO, AMED and Internurse were systematically searched from inception to December 2019. Data were mapped directly into the Theoretical Domains Framework (TDF), a psychological framework that includes 14 domains relevant to behaviour change. Thematic synthesis was used to identify potential barriers and enablers within each domain. Data were then matched to the three components of the COM-B model: Capability, Opportunity, and Motivation.ResultsTwenty studies met the eligibility criteria. The findings of this review indicate that shared decision-making is not a concept commonly used in mental health services when exploring processes of risk assessment and risk management. The key barriers identified were ‘power and best interest’ (social influences) and ‘my professional role and responsibility’ (social/professional role and identity). Key enablers were ‘therapeutic relationship’ (social influences) and ‘value collaboration’ (reinforcement). The salient barriers, enablers and linked TDF domains matched COM-B components ‘opportunity’ and ‘motivation’.ConclusionThe review highlights the need for further empirical research to better understand current practice and mental health professionals’ experiences and attitudes towards shared decision-making in risk assessment and risk management.

Highlights

Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place
Despite professionals reporting a high rate of service user involvement, these findings suggest that Shared Decision Making (SDM) is not routinely nor fully implemented
Study selection A total of 8211 papers were yielded in the databases searches; and 1420 additional papers were included from other sources

Summary

Introduction

Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. For a decision to be ‘shared’ it must involve: at least two participants, the sharing of information, and a decision that is made and agreed upon by all parties [1] These criteria are reflected in a shared decision model [2], which proposes that SDM occurs when all participants are informed, involved, and influential in the decision-making process. It is, emphasised that the three SDM components are on a sliding scale of influence that is dependent on context, capacity and desire to influence [2]. While healthcare professionals may be experts in diagnosis, aetiology, prognosis, treatment options, and outcome probabilities [3]; service users are experts about the impact of the condition on their lives, their preferences, their personal attitudes towards risks, and often know what works best for them regarding their condition and treatment [4]

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