Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

Abstract

Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions.The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

The deadlock of saying “That is what we already do!” A thematic analysis of mental healthcare professionals’ reactions to using an evidence‐based intervention

“…Their perception of GSD being the same as their traditional clinical practice might be due to the fact that, in principle, they were good advocates for patient involvement and shared decision‐making (SDM), yet failing to realize it in practice (Zoffmann & Kirkevold, ). This is in accordance with Schön, Grim, Wallin, Rosenberg, and Svedberg (), who carried out a similar study investigating psychiatric staff perceptions of the implementation of a SDM tool. Although the staff also stated that SDM already was familiar to them and being used in daily practice, they described their usual practice without SDM (Schön et al, ).…”

“…This is in accordance with Schön, Grim, Wallin, Rosenberg, and Svedberg (), who carried out a similar study investigating psychiatric staff perceptions of the implementation of a SDM tool. Although the staff also stated that SDM already was familiar to them and being used in daily practice, they described their usual practice without SDM (Schön et al, ). This inconsistency between professionals’ values and the care they actually provide might benefit from an intervention like GSD where the reflection sheets serve as supportive tools for acknowledging and learning from the patients’ reflections on their way of managing their psychiatric condition.…”

“…This was further supported by their statements that patients lacked willingness and ability to use GSD. The last was also a finding from the study by Schön et al (). When implementing evidence‐based interventions in the future, it is therefore important to show consideration for older professionals with long experience.…”

Self-managed programmes in homeless care as (reinvented) institutions

“…Organizational interventions can help break through institutionalized behaviour, such as enforcing consumer rights, offering role certainty and predictability for both clients and staff, creating transparency and offering opportunities for participation (Hoijtink & Oude Vrielink, 2007;Kruiter et al, 2008;Schön, Grim, Wallin, Rosenberg, & Svedberg, 2018;Scott, 2005). It is argued that increased space for participation of both clients and staff, more custom made care and higher staff satisfaction is associated with better outcomes for clients (Jongepier, Struijk, & Van Der Helm., 2010;Schön et al, 2018). Staff satisfaction is stimulated by institutional and practical support (Chou & Robert, 2008).…”

The development and process evaluation of the ACTION study: A person-centred communication intervention targeting nurse assistants in home care for older persons

“…As emphasized by Schön et al (37) and Rogers (38), the importance of local champions when implementing innovative tools and technologies in organizations must be addressed. Hence, as this study shows, identifying, planning for and clarifying the different roles of those involved in the intervention, and the functions and expectations related to these roles, is crucial early in the process.…”