Predicting the preferences for involvement in medical decision making among patients with mental disorders

Michaelis, Svea; Kriston, Levente; Härter, Martin; Watzke, Birgit; Schulz, Holger; Melchior, Hanne

doi:10.1371/journal.pone.0182203

Cited by 14 publications

(17 citation statements)

References 60 publications

(90 reference statements)

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“…In line with existing research, 19 – 25 the majority of the participants interviewed in our study generally prefer a collaborative role regarding medical decisions. Patients wanted to be involved in the decision-making process prior to their current inpatient treatment and reported high information needs regarding treatment options in order to feel empowered to participate adequately in the decision for a certain treatment setting.…”

Section: Discussionsupporting

confidence: 85%

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Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study

Kivelitz¹,

Härter²,

Mohr³

et al. 2018

PPA

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BackgroundDecisions on medical treatment setting are perceived as important but often difficult to make for patients with mental disorders. Shared decision-making as a strategy to decrease decisional conflict has been recommended, but is not yet widely implemented. This study aimed to investigate the information needs and the decision-making preferences of patients with mental disorders prior to the decision for a certain treatment setting. The results will serve as a prerequisite for the development of a high-quality patient decision aid (PtDA) regarding the treatment setting decision.MethodsWe conducted retrospective individual semi-structured interviews with n=24 patients with mental disorders in three psychotherapeutic inpatient care units. The interviews were audiotaped, transcribed, coded, and content-analyzed.ResultsThe majority of the patients wanted to be involved in the decision-making process. They reported high information needs regarding treatment options in order to feel empowered to participate adequately in the decision for a certain treatment setting. However, some patients did not want to participate or receive information, for example, because of their high burden of mental disorder. Whereas the majority were satisfied with the extent they were involved in the decision, few participants felt sufficiently informed about treatment options. Most patients reported that a decision aid regarding an appropriate treatment setting would have been helpful for them. Important information that should be included in a PtDA was general information about mental illness, effective treatment options, specific information about the different treatment settings, and access to treatment.DiscussionThe identified information and decision-making needs provide a valuable basis for the development of a PtDA aiming to support patients and caregivers regarding the decision for an adequate treatment setting. As preferences for participation vary among patients and also depend on the current mental state, a flexible approach is needed to meet patients’ individual wishes and needs.

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Section: Discussionsupporting

confidence: 85%

“… 18 Furthermore, the majority of patients with mental disorders prefer to be involved in treatment decision-making. 19 – 25 Although there is international consensus about the importance of SDM, 11 it is not yet widely implemented. 11 , 26 – 28 …”

Section: Introductionmentioning

confidence: 99%

Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study

Kivelitz¹,

Härter²,

Mohr³

et al. 2018

PPA

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“…The recent MAGIC study explored how shared decision-making could be embedded within the UK NHS, and identified many challenges. These include misplaced confidence amongst staff about their current practice, a perceived lack of tools to support shared decision-making and inaccurate assumptions about patients’ preferences [ 16 , 17 ]. MAGIC examined a number of clinical contexts, but excluded mental health, where shared decision-making faces particular challenges, reflecting a unique history founded on concepts of containment and coercion [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

et al. 2018

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BackgroundSevere mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning.MethodsWe cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of ‘autonomy support’. Primary and secondary outcomes were collected by self-report, six months after allocation.FindingsIn total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome.ConclusionsAn intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term.

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“…Because of their fatalistic perspective, it was impossible to motivate this type for methods such as pleasant activations or other techniques of problem solving (35). There are further similarities to a quantitative study of Michaelis et al (36) who described types of people with a mental illness and their preferences on shared decision-making. They differentiate between autonomous, collaborative, and passive types in terms of different predictive values.…”

Section: Types Of Utilizationmentioning

confidence: 97%

“…They differentiate between autonomous, collaborative, and passive types in terms of different predictive values. Participants with a high burden of depressive symptoms and low perceived selfefficacy withdrew into a passive treatment role (36). De Smet et al (37) described this phenomenon as "being stuck between knowing vs.…”

Section: Types Of Utilizationmentioning

confidence: 99%

Types of Utilization and Types of Treatment Response in a Collaborative Care Approach for Depressive Disorders in Old Age in Primary Care

2020

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Background: Treatment of depressive disorders in old age is hindered by several barriers. Most common are time pressure in primary care and latency for specialized therapeutic care. To improve treatment, the collaborative care approach GermanIMPACT was evaluated in a cluster-randomized controlled trial. Care managers offered a complex stepped-care intervention of monitoring, psychoeducation, and behavioral activation techniques. Twenty-six percent of the intervention group responds with a remission of depressive symptoms compared with 11% who received treatment as usual (TAU). The low-threshold intervention was more successful than TAU. Nevertheless, three-quarters did not respond with a remission. The aim of this study is to identify and describe the different types of utilization and of treatment response to understand what constitutes an effective intervention. Methods: Of 64 patients from the intervention group, we carried out problem-centered interviews with 26 patients from the intervention group. We analyzed the interviews using a qualitative type-building content analysis. For type construction, we performed a contrasting case comparison, regarding inductive and deductive categories of the intervention utilization and the symptom development. Results: The 26 participants' ages ranged from 62 to 87 years (mean = 72 years). Three participants were male. We identified five types of utilization, which differ primarily in the realization of pleasant activations, depending on own activity at the beginning and during the therapy: "activatable relief seekers," "active relief seekers," "active relaxation seekers," "passive problem-solving seekers," and "passive relief seekers." In the second typology, we analyzed four deductively determined types of treatment response responders, slight improvers, constant moderates, and non-responders. Patient-specific characteristics are a recent history of depression, an affinity for activities, supportive contacts, and limited comorbidity. In contrast, non-responders report contrary characteristics. Conclusion: Our two typologies emphasize that an effective intervention requires a match between intervention components and patient characteristics. We saw no intersections between utilization and treatment response. GermanIMPACT is an effective Kloppe et al. Depressive Disorders in Old Age low-threshold intervention for moderately burdened patients, who are still capable of self-activation. An expansion of the intervention, especially for depression with a long history and comorbidities impairing mobility, could increase the effectiveness and improve the care situation of older people suffering from depression.

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Predicting the preferences for involvement in medical decision making among patients with mental disorders

Cited by 14 publications

References 60 publications

Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study

Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study

Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

Types of Utilization and Types of Treatment Response in a Collaborative Care Approach for Depressive Disorders in Old Age in Primary Care

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