Critical Issues for Psychiatric Medication Shared Decision Making with Youth and Families

O’Brien, Megan; Crickard, Elizabeth; Rapp, Charles A.; Holmes, Cheryl; McDonald, Thomas P.

doi:10.1606/1044-3894.4135

Cited by 25 publications

(22 citation statements)

References 67 publications

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“…There has been recent enthusiasm for the application of shared decision making (SDM) to the area of youth mental health, including depression . However, the rates of SDM in routine mental health care are likely to be low if adult data are any indication ,.…”

Section: Introductionmentioning

confidence: 99%

Right choice, right time: Evaluation of an online decision aid for youth depression

Simmons

Elmes

McKenzie

et al. 2016

Health Expectations

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BackgroundAppropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this.ObjectivesThe main objective of this study was to evaluate an online decision aid for youth depression.DesignAn uncontrolled cohort study with pre‐decision, immediately post‐decision and follow‐up measurements.Setting and ParticipantsYoung people (n=66) aged 12‐25 years with mild, mild‐moderate or moderate‐severe depression were recruited from two enhanced primary care services.InterventionOnline decision aid with evidence communication, preference elicitation and decision support components.Main outcome measuresThe main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow‐up.ResultsAfter using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3‐22.9 points lower) on the Decisional Conflict Scale (range 0‐100)) and felt involved and satisfied with their decision. At follow‐up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3‐4.0 points lower) on the Patient Health Questionnaire nine‐item scale (range 0‐27)) and were adherent to 88% (95% CI: 82%‐94%) of treatment courses.Discussion and ConclusionsA decision aid for youth depression can help ensure evidence‐based, client‐centred care, promoting collaboration in this often difficult to engage population.

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Section: Introductionmentioning

confidence: 99%

Right choice, right time: Evaluation of an online decision aid for youth depression

Simmons

Elmes

McKenzie

et al. 2016

Health Expectations

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“…Children in acute care settings, for instance, report feeling alienated when clinicians speak only to their parents and that a lack of communication is a barrier to SDM (Kelsey et al, 2007;O'Brien, Crickard, Rapp, Holmes, & McDonald, 2011). Studies in child mental health settings have found that interventions that include SDM reduce (child-reported) decisional conflict and improve treatment outcome, in terms of (child-reported) depression, quality of life, and satisfaction (Asarnow et al, 2009;Richardson, McCauley, & Katon, 2009;Westermann, Verheij, Winkens, Verhulst, & Van Oort, 2013).…”

mentioning

confidence: 99%

The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data

Edbrooke‐Childs

Jacob

Argent

et al. 2015

Clin Child Psychol Psychiatry

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“…The Preparing for the Appointment (PFTA) worksheet was developed as part of a shared decision‐making model for youth and parents during psychiatric medication appointments (see Crickard, O'Brien, Rapp, & Holmes, ; O'Brien, Crickard, Rapp, Holmes, & McDonald, ). During development, parents and teens expressed a strong desire for a hands‐on tool they could use to help engage with one another and with their medication provider.…”

Section: Introductionmentioning

confidence: 99%

“…During development, parents and teens expressed a strong desire for a hands‐on tool they could use to help engage with one another and with their medication provider. Based on findings from several focus groups with teens, parents, and providers, the content of the PFTA worksheet was designed to capture not only what providers were interested in knowing for each appointment but also, more importantly, what parents and teens wanted to communicate (Crickard et al., ; O'Brien et al., ). The first part of the worksheet asks three questions about topics for today's appointment; the second section has four items asking about issues since the last appointment.…”

Section: Introductionmentioning

confidence: 99%

Innovations in Practice: Supporting parent and teen communication during outpatient psychotropic medication appointments

O’Brien

Holmes

Chapman

et al. 2014

Child Adoles Ment Health

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Background: Encouragement of youth participation in mental health treatment is relatively new and there have been few specific interventions to improve engagement, particularly as it relates to medication management. This article describes the development of a tool to support engagement during medication appointments by identifying areas of agreement/disagreement between parents and teens. Method: Data were analyzed from 240 parent/teen dyads visiting an outpatient community mental health center for medication management. Frequencies and percentages were calculated for all items. Kappa scores were used to assess agreement between parent and teen dyads. Results: The level of agreement between parents and teens was low. Overall, teens expressed preference for discussion of 'positive' aspects of treatment such as what is going well, whereas parents preferred to focus on 'negative' aspects of treatment such as problematic symptoms. The lowest level of agreement was found for the item: 'My teen seems to be having problems with energy levels' (Kappa = .19; 95% CI = .05-.34). The strongest level of agreement was for the question 'How has your teen been using the medication since the last appointment?' (Kappa = .56; 95% CI = .44-.69). Conclusions: The findings support the utility of the tool for illustrating the variation in needs of teens and parents during medication appointments. Knowledge of these differences can be used by providers to encourage teen participation and may enhance overall communication. Key Practitioner Message• Parents and teens often have different agendas for medical appointments and value hands-on tools to assist with communication during psychiatric medication appointments.• The Preparing for the Appointment worksheet represents one hands-on option clinicians can use to reveal divergent parent/teen perspectives.• Clinicians can use the worksheet to facilitate communication, to amplify teen voice and to empower both parents and teens to communicate with one another and with providers.

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Critical Issues for Psychiatric Medication Shared Decision Making with Youth and Families

Cited by 25 publications

References 67 publications

Right choice, right time: Evaluation of an online decision aid for youth depression

Right choice, right time: Evaluation of an online decision aid for youth depression

The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data

Innovations in Practice: Supporting parent and teen communication during outpatient psychotropic medication appointments

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