Measurement issues of shared decision making in mental health: challenges and opportunities

Abstract

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

Translation and psychometric testing of a decision‐making scale

“…the deliberation behaviour of health professionals) or decision outcomes (e.g. satisfaction with the decision) (Perestelo-Perez et al, 2017).…”

Which instruments are used to measure shared, supported and assisted healthcare decision-making between patients who have limited, impaired or fluctuating capacity, their family carers and healthcare professionals? A systematic review protocol

“…Several different instruments have been developed to assess the complex and multifaceted phenomenon of shared decision-making in the healthcare setting ( Bouniols et al ., 2016 ; Makoul & Clayman, 2006 ; Scholl et al ., 2011 ; Simon et al ., 2007 ). These scales measure different components or phases in the SDM process between physicians and patients having cognitive capacity, such as antecedents of the decision-making process, the process itself and the decision outcomes ( Perestelo-Perez et al ., 2017 ; Scholl et al ., 2011 ).…”

“…(2016) , highlighting the evolution of instruments which take into account points of view of patients, HCPs and external observers. Recently, Perestelo-Perez et al (2017) focused on SDM measures within the mental health area and reported 48 instruments, mainly assessing the SDM process from the patients’ perspective.…”

Shared decision making in mental health: special issue of the Mental Health Review Journal

“…Reflection on SDM training for service users, care-coordinators and psychiatrists given by O'sullivan and Rae in the paper on implementation of SDM helps to understand better what each group looks for in SDM and in training for it. Evaluation of both SDM measures in mental health is essential to enable SDM to meet the promise of improving communication and mutual learning (Perestelo-Perez et al, 2017) Key issues that require clarification in the context of SDM include what are effective processes of sharing such different types of knowledge between service users and providers who have unequal power positions in our respective societies? What are the necessary and sufficient conditions for a trusting and respectful relationships between these key stakeholders and relevant others (such as family members)?…”

“…, the range of SDM interventions and their underlying components (Zisman-Ilani et al, 2017), SDM from the perspective of recovery-oriented person centred care (Davidson et al, this issue), SDM measures and outcomes(Perestelo-Perez et al, 2017), and the implementation of SDM in everyday practice(Ramon et al, 2017), of which relatively little has been published up to now.…”