Shared decision-making in the treatment of bipolar disorder: findings from a nationwide naturalistic cohort study in everyday clinical practice.

Abstract

Shared decision-making (SDM) is of increasing importance in mental health care, however, large studies on the effects of SDM in bipolar disorder (BD) are scarce. To gain insight into the relationships between SDM, guideline concordance of treatments in everyday practice, satisfaction with care, and medication adherence in BD. In a nationwide observational study on the treatment of BD, patients were asked questions about their involvement in treatment. These questions were clustered according to the three-talk model (TTM) for SDM, which involves team talk, option talk, and decision talk. A composite concordance score for multimodal treatments was made, and satisfaction with care (score 1 to 10) and medication adherence (DAI-10) were measured. 839 patients with BD from various outpatient treatment centers were included. Patients were highly involved in decision-making. In multiple regression, team talk was significantly positively associated with guideline concordance (b = 5.10, p = .045), and decision talk was positively associated with satisfaction with care (b = 0.82, p < .001) and medication adherence (b = 1.18, p = .003). Positive associations were found between SDM, guideline concordance, satisfaction with care, and medication adherence, suggesting that investing in these steps of the decision-making process together with patients and their significant others, will help to improve quality of care.