Abstract
Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.
Highlights
If psychiatry was an accurate science, there would be one proper answer for each mental health problem and the patients’ preferences about treatments would be irrelevant to what is “right”
We registered a high response rate of 85% resulting in a sample of 152 psychiatric outpatients with affective disorders
It is remarkable that almost all psychiatric outpatients with affective disorders (91%) preferred to leave final decisions to their psychiatrist and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information, both responses indicative of a physician-directed style
Summary
If psychiatry was an accurate science, there would be one proper answer for each mental health problem and the patients’ preferences about treatments would be irrelevant to what is “right”. Psychiatry is just an uncertain science with many clinical situations in which more than one reasonable possibility of intervention is available with no evidence that any of the alternatives is better than another. Shared decision-making (SDM) is a patient-centered approach in which the healthcare professional and patient exchange information on the best available treatment and discuss the implications of each option [2,3,4]. Patient autonomy is respected, the patient is assisted with setting their values and preferences, and final treatment decisions reflect a mutual agreement between patient and physician rather than a unilateral decision taken solely by the physician, or by the patient.
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