Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry

Natalie J Maples,Dawn I Velligan,Erin M Espinosa,Eric C Jones,Melissa A Valerio-Shewmaker,Robert O Morgan

doi:10.1007/s10597-021-00856-z

Abstract

There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.

Highlights

Engagement in mental health services following psychiatric hospitalization is of critical importance for improving the lives of individuals with severe mental illness and reducing long term negative outcomes, such as hospitalization, homelessness and suicide (Velligan et al, 2009; Pasic et al, 2005)
Given that Shared Decision Making (SDM) is a model based on transaction and personal interaction mediated by various kinds of aids or tools (Curtis et al, 2010), the design involved semi-structured interviews to produce data that could be explored inductively regarding the kinds of aids, tools and barriers to effective shared decision making
Providers and patients agreed a discussion can still transpire that can minimize the negative feelings associated with not having a full or real choice. This is the first evaluation of the perceptions and preferences of individuals living with serious mental illness and their providers regarding SDM in a clinic serving this population immediately following a psychiatric crisis or hospitalization

Summary

Introduction

Engagement in mental health services following psychiatric hospitalization is of critical importance for improving the lives of individuals with severe mental illness and reducing long term negative outcomes, such as hospitalization, homelessness and suicide (Velligan et al, 2009; Pasic et al, 2005). Various intervention approaches have been used to increase engagement in outpatient treatment in serious mental illness (Roberts & Bailey, 2011), most methods do not emphasize the importance of the individuals participating in their own treatment decisions. SDM is a structured approach to communication in medicine that frames the interaction as a negotiation between mutual experts (patient and provider) and stresses the balanced use of empirical information and patient preferences and values in decision making (Charles et al, 1997). SDM is compatible with evidence-based medicine in its emphasis on the use of empirical information to make treatment decisions (Montori & Guyatt, 2001), and with the mental health recovery movement in its emphasis on patient-centered care (Drake et al, 2010). The process of recovery from mental health conditions depends on people in treatment taking personal accountability for medical decisions, including those about medications and types of therapies

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