Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study

Abstract

Background Shared decision making (SDM) is a process where the patient and the health professional collaborate to make decisions based on both the patient’s preferences and the best available evidence. Patients with psychotic disorders are less involved in making decisions than they would like. More knowledge of these patients’ experiences of SDM may improve implementation. The study aim was to describe and explore experiences of SDM among patients with psychotic disorders in mental health care. Methods Individual interviews were conducted with ten persons with a psychotic disorder. They were service users of two community mental health centres. The transcribed material was analysed using qualitative content analysis. Results Four-fifths of the participants in this study found that they received insufficient information about their health situation and treatment options. All participants experienced that only one kind of treatment was often presented, which was usually medication. Although the study found that different degrees of involvement were practised, two thirds of the participants had little impact on choices to be made. This was despite the fact that they wanted to participate and felt capable of participating, even during periods of more severe illness. The participants described how important it was that SDM in psychosis was based on a trusting relationship, but stated that it took time to establish such a relationship. Conclusions This study with ten participants indicates that patients with psychotic disorders experienced that they were not allowed to participate as much as they wanted to and believed they were capable of. Some patients were involved, but to a lesser degree than in SDM. More and better tailored information communicated within a trusting relationship is needed to provide psychotic patients with a better basis for active involvement in decisions about their health care.

Assessing psychotic spectrum disorders in partnership with patients: Three culturally responsive therapeutic assessment cases.

“…Shared decision-making (SDM) models, an approach in which patients and providers collaborate to make health care decisions based on patient preference and the best available evidence, have been recommended for use with people with PSDs (Charles et al, 1997). SDM is associated with patient satisfaction and fewer decision conflicts (Haugom et al, 2022). However, researchers have shown SDM to be inconsistently implemented among patients with PSDs, particularly those who have experienced involuntary treatment (Drivenes et al, 2020) despite patients’ positive responses to SDM (Haugom et al, 2022).…”

“…SDM is associated with patient satisfaction and fewer decision conflicts (Haugom et al, 2022). However, researchers have shown SDM to be inconsistently implemented among patients with PSDs, particularly those who have experienced involuntary treatment (Drivenes et al, 2020) despite patients’ positive responses to SDM (Haugom et al, 2022). This is likely due to barriers such as providers’ parentalistic approach to care and beliefs that patients with PSD cannot feasibly or thoughtfully partake in SDM (Zisman-Ilani et al, 2017).…”

“…Yet, in most cases, patients with PSDs are often only informed of medication options (Shepherd et al, 2014). In TA, the assessment questions are driven by the patient and may thus result in recommendations that more closely align with the patient’s view of recovery as well as expanded treatment options (Haugom et al, 2022; Zisman-Ilani et al, 2017).…”

Shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): protocol for a realist review

“…[6,8] Research has shown that the practice of SDM is highly acceptable amongst patients with enduring psychotic illnesses and psychiatrists, [9,10,11] although differences in attitudes towards and subsequent participation in SDM have been identified in the case of the latter. [12] However, the practice of SDM has yet to be successfully adopted for routine use in psychiatric settings amongst patients with severe mental illnesses. [13] Suboptimal rates of SDM adoption are particularly prominent during antipsychotic treatment decisions amongst patients with psychotic illnesses.…”

Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study

“…Patients receiving mental health care in Norway have the right, as far as is reasonable, to choose between different mental health treatment options, including treatment without medication [ 23 ], such as family interventions or cognitive behavioural therapy [ 24 , 25 ]. Despite this, recent studies show that SDM for patients with psychotic disorders is often limited to making choices between different types of antipsychotic medication [ 26 , 27 ]. This highlights the importance of examining the association between SDM and patients’ perceptions of being respected for their desire not to use medication.…”