Overcoming Obstacles to Shared Mental Health Decision Making

Guidry‐Grimes, Laura

doi:10.1001/amajethics.2020.446

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…Insight has been proven to enhance medication adherence and long-term clinical outcomes and offer a better quality of life ( 77 ). A recent review in a journal of ethics suggests that a patient's lack of insight should not be a reason for healthcare providers to abandon decision-sharing with a patient ( 78 ). It would be ethical for clinicians to improve their patients' insight about the proven benefits and assist autonomous role preference and SDM at the same time in order to facilitate recovery.…”

Section: Discussionmentioning

confidence: 99%

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Ismail

Midin

2021

Front. Psychiatry

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Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia.Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses.Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = −0.33, 95% CI = −0.67 to −0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39–30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72–0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10–7.82).Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.

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Section: Discussionmentioning

confidence: 99%

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Ismail

Midin

2021

Front. Psychiatry

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“…The stigma attached to complex mental health conditions experienced by medical staff, patients, and their families represents an overarching obstacle to autonomous decision making among schizophrenia and bipolar disorder patients [41]. Person-centered care in mental health services is a key opportunity to acknowledge mental health patients' capacity to decide on their healthcare issues [42] and to overcome barriers to the empowerment of individuals with a mental illness [43].…”

Section: Discussionmentioning

confidence: 99%

What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

Pons

Calcedo‐Barba

Hastings

et al. 2021

Psychiatry International

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Background: Research on the decisional capacity of schizophrenia and bipolar disorder patients mostly reflects the hospital context. Aim: To describe the views of patients, psychiatrists, and caregivers on the capacity of individuals with schizophrenia and bipolar disorder to make everyday decisions on their care related to their illness. Methods: A survey was conducted among schizophrenia and bipolar disorder patients, psychiatrists, and caregivers (June 2019 to January 2020; seven countries). A questionnaire was emailed to members of the Global Alliance of Mental Illness of Advocacy Network—Europe (GAMIAN; patients) and the European Federation of Families of People with Mental Illness (EUFAMI; caregivers) and to psychiatrists who voluntarily agreed to participate. Questions referred to patients’ involvement and capacity for healthcare decision making, and to barriers to and opportunities for autonomous decision making. Frequency, agreement, and importance were rated on Likert scales. Descriptive statistics were conducted. Results: 21 schizophrenia or bipolar disorder patients (52.3% female; mean age (years) ± SD: 50.71 ± 12.02), 11 psychiatrists (18.2% female), and 15 caregivers (86.6% female; 100% family related) participated in the survey. In total, 86% of patients felt frequently involved in decisions about everyday care and medications, and 91% of psychiatrists and 40% of caregivers perceived the same; 38% of patients felt frequently involved in decisions about the use of acute symptom medications, and 57% on care planning, and 55% and 82% of psychiatrists, and 40% and 53% of caregivers, respectively, believed the same; and 86% of patients, 91% of psychiatrists, and 47% of caregivers agreed on the capacity of schizophrenia or bipolar disorder patients to value the implications of taking medicines to prevent acute psychotic crises. Poor understanding and training are barriers, while advocacy and increasing interest in patients’ needs are opportunities for increasing autonomous decision making. Conclusions: Stakeholders concur that schizophrenia and bipolar disorder patients have the capacity to make everyday decisions around their care related to their illness, including acute symptom management. Barriers and opportunities exist to foster autonomous decisions among mental illness individuals.

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“…SDM can be difficult when patients do not recognise or deny having a mental health problem or when patients and clinicians have very different opinions about the diagnosis or treatment plan, which may even cause either or both parties to refrain from or refuse to engage in SDM (Adams & Drake, 2006 ; Guidry-Grimes, 2020 ; Hamann et al, 2003 ; Morán-Sánchez et al, 2019 ). For example, one can imagine that someone with anorexia nervosa will not agree with gaining weight as a treatment goal or even refuse to see the weight loss as a problem or illness in the first place (Brennan et al, 2019 ).…”

Section: Barriers At the Micro Level: In The Consultation Roommentioning

confidence: 99%

“…There are also clinicians who claim “they are already using SDM” while the evidence shows the contrary (Brooks et al, 2019 ; Curtis et al, 2010 ; Farrelly et al, 2014 ; Hamann & Heres, 2014 ; Hopwood, 2020 ). Both patients and professionals describe cynicism or pessimism as being non-helpful attitudes (Brooks et al, 2019 ; Morant et al, 2016 ), with negative countertransference and clinicians’ therapeutic pessimism undermining their therapeutic capacity and thereby the SDM process (Guidry-Grimes, 2020 ).…”

Section: Barriers At the Micro Level: In The Consultation Roommentioning

confidence: 99%

Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care

Verwijmeren,

Grootens

2023

Community Ment Health J

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Although shared decision making (SDM) has become the most preferable way in doctor–patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.

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Overcoming Obstacles to Shared Mental Health Decision Making

Cited by 6 publications

References 22 publications

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care

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