Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study

Haugom, Espen Woldsengen; Stensrud, Bjørn; Beston, Gro; Ruud, Torleif; Landheim, Anne

doi:10.1186/s12913-020-05949-1

Cited by 23 publications

(17 citation statements)

References 32 publications

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“…In our study, the patients found that the professionals mainly presented information about a medicine when deciding on treatment. This is in line with a study that showed that health care professionals at the same CMHCs from which we recruited patients felt that SDM was about choosing antipsychotic medicine [ 29 ]. A previous study found that health care professionals sometimes decided not to inform patients about alternatives to the treatment they considered most relevant [ 33 ].…”

Section: Discussionsupporting

confidence: 89%

“…This finding is interesting in light of another study of the same CMHCs as those included in this study. That study found that health professionals felt that informing patients about their health situation was an important aspect of SDM [ 29 ]. This may mean that patients and professionals at the same CMHCs have different experiences of the degree to which information is provided.…”

Section: Discussionmentioning

confidence: 99%

“…However, implementation in mental health care remains limited [ 7 ]. Health professionals mention reduced decisional capacity as a barrier to using SDM with patients with psychotic disorders [ 28 , 29 ]. Barriers among patients with schizophrenia may be experiences of powerlessness due to coercive treatment that even many years later prevent them from expressing their ideas and preferences [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Shared decision‐making in mental health settings remains limited, and focused on discussions about medications, with psychosocial approaches frequently presented as complimentary to medication rather than an alternative (Haugom et al . 2020). Additionally, clinicians’ low expectations of consumers’ ability to engage in shared decision‐making act as a further barrier (Dawson et al .…”

Section: Discussionmentioning

confidence: 99%

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients

Dawson

Oster

Scanlan

et al. 2022

Int J Mental Health Nurs

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Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma‐informed and recovery‐orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over‐reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self‐initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed‐methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in‐depth interviews with consumers (n = 12) and clinicians (n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three‐month period following implementation (mean difference from baseline = −30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.

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“…9,10 Poor service user involvement is also reflected in a study of mental health professionals' experiences with shared decision-making with service users with psychotic disorders, concluding that shared decision-making is practiced to only a limited extent with this group. 11 Involuntary medication has been found to be a particularly problematic form of coercion in service users' experience. 10 The majority of admitted service users in mental health care are treated with medication.…”

Section: Introductionmentioning

confidence: 99%

Why Service Users Choose Medication-Free Psychiatric Treatment: A Mixed-Method Study of User Accounts

Standal¹,

Solbakken²,

Rugkåsa³

et al. 2021

PPA

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Purpose Medication has been a central part of treatment for severe mental disorders in Western medicine since the 1950s. In 2015, Norwegian Health Authorities decided that Norwegian health regions must have treatment units devoted to medication-free mental health treatment to enhance service users’ freedom of choice. The need for these units has been controversial. The aim of this study was to examine why service users choose medication-free services. This article examines what purpose these units serve in terms of the users’ reasons for choosing this service, what is important for them to receive during the treatment, and what factors lay behind their concerns in terms of medication-related views and experiences. Methods Questionnaires were answered by 46 participants and 5 participants were interviewed in a mixed-method design integrated with a concurrent triangulation strategy applying thematic analysis and descriptive statistics. Results Negative effects of medications and unavailable alternatives to medication in ordinary health care were important reasons for wanting medication-free treatment. Medication use may conflict with personal values, attitudes, and beliefs. Conclusion This study broadens the understanding of why the demand for separate medication-free units has arisen. The findings may contribute to making medication-free treatment an option in mental health care in general. To this end, clinicians are advised to communicate all treatment alternatives to service users and to be mindful of the effect of power imbalances in their interactions with them.

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Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study

Cited by 23 publications

References 32 publications

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

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

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients

Why Service Users Choose Medication-Free Psychiatric Treatment: A Mixed-Method Study of User Accounts

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