Recent advances in shared decision making for mental health

Patel, Sapana R.; Bakken, Suzanne; Ruland, Cornelia M.

doi:10.1097/yco.0b013e32830eb6b4

Cited by 122 publications

(132 citation statements)

References 32 publications

(37 reference statements)

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“…The model of shared decision making (SDM) reconceptualizes client-clinician communication (Patel, Bakken & Ruland, 2008) by redefining the terms by which participants come together to make treatment decisions (Drake, Deegan & Rapp, 2010). In a SDM frame, neither clinicians (paternalistic model) nor clients (informed choice model) are singularly responsible for making decisions (Makoul & Clayman, 2006).…”

Section: Making (Cmsdm) To Propose a Communication-centered Epistemicmentioning

confidence: 99%

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Mikesell

Bromley

Young

et al. 2015

Health Communication

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Shared decision making (SDM) interventions aim to improve client autonomy, information sharing and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued clientcentered priorities such as autonomy and empowerment when making decisions.However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: 1) the role of communication and information exchange and 2) the value and stability of clinician and client epistemic expertise.Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of SharedDecision Making (CEM-SDM).3The quality of mental health care has been argued to be largely dependent on the quality of client-clinician communication (Priebe & McCabe, 2008), which is critical for accomplishing clinical tasks and improving health outcomes (Alegría et al., 2008;Wissow et al., 2008). The model of shared decision making (SDM) reconceptualizes client-clinician communication (Patel, Bakken & Ruland, 2008) by redefining the terms by which participants come together to make treatment decisions (Drake, Deegan & Rapp, 2010). In a SDM frame, neither clinicians (paternalistic model) nor clients (informed choice model) are singularly responsible for making decisions (Makoul & Clayman, 2006). Instead, decision making is characterized by the exchange of unbiased information (Drake et al., 2010), collaboration (Charles, Gafni & Whelan, 1999) and mutual respect for differing expertise (Deegan & Drake, 2006). Given the centrality of communication in mental health care, we believe the assumptions underlying SDM warrant critical examination.For instance, despite widespread support for SDM, its principles are not uniformly perceived or advocated. Not all clients desire high levels of autonomy (Levinson, Kao, Kuby & Thisted, 2005; Say, Murtagh & Thompson, 2006), and psychiatrists have been found to both value and criticize elements of SDM including the exchange of unbiased information (Seale, Chaplin, Lelliott & Quirk, 2006). To elucidate these discrepancies, we elicited perspectives from clients and mental health clinicians about their experiences making and facilitating medication decisions and about strategies that might suppo...

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Section: Making (Cmsdm) To Propose a Communication-centered Epistemicmentioning

confidence: 99%

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Mikesell

Bromley

Young

et al. 2015

Health Communication

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“…In addition to being psychotherapeutically-oriented, multiprofessional family discussions therapy meetings are also scenes of shared decision making. As in studies concerning SDM, the patients (and family members) in this research often felt they had less influence than they would have wished, and they also felt a long-term compassionate relationship to be important (Patel, Bakken, & Ruland, 2008;. However, the results of this research indicate that, before making any crucial decisions, the main goal at the start of treatment for psychotic crises should be the creation of dialogue with the clients, a point which has been emphasized by several other authors .…”

mentioning

confidence: 80%

The Need-Adapted Approach in Psychosis: The Impact of Psychosis on the Treatment and the Professionals

Borchers¹,

Seikkula

Arnkil

2014

Ethical Hum Psychol Psychiatry

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This research aimed to describe the inner dialogues of psychiatrists in the context of the Need-Adapted treatment of psychosis. It strived to show that the experiences of professionals can have an impact on the treatments offered. In addition, the research aimed to clarify how the phenomenon of professionals' inner dialogues may be studied.The data for the three studies of the research consisted of eight videotaped and transcribed stimulated recall interviews with psychiatrists, who recalled their inner dialogues, assisted by videos from co-research interviews. The dialogues took place in multi-agent discussions with patients, with the family members of patients, and with other professionals. The first study provided an overall picture of the research material, with a focus on psychiatrists' inner dialogues concerning their workmates. The second study focused on how the psychiatrists viewed their agency. The third study dealt with the impact of psychosis on the treatment, the psychiatrists, and other professionals. The first two studies used adaptations of dialogical-narrative analysis, while the third study used an adaptation of qualitative content analysis.From the perspective of real-world clinical practice the studies suggested the following: (i) since psychiatrists interact with the clients and with other professionals, they respond as embodied individual human beings with possibly strong emotions; this suggests that the experiences and inner dialogues of the participants may be interdependent; (ii) clinician-clinician relationships can be of crucial importance in the treatment; (iii) especially in the inpatient setting, institutional forces can have an enormous impact on psychiatrists' agency by reducing professional creativity, and occasionally, by leading to a kind of agentless situation; (iv) psychiatrists seem to be more or less aware of the many harmful effects of (in particular) inpatient treatment; (v) the interview methods used in the research increased professionals' reflective opportunities, indicating that such interviews could be helpful in the dilemmas professionals encounter in practice. Tämän tutkimuksen tavoite oli kuvata psykiatrien sisäistä keskustelua psykoosien tarpeenmukaisen hoitomallin kontekstissa. Se pyrki osoittamaan, että ammattilaisten kokemuksilla voi olla vaikutusta tarjottuun hoitoon, ja selvittä-mään, miten ammattilaisten sisäistä keskustelua voidaan tutkia. Kolmen osatutkimuksen aineisto koostui kahdeksasta videolle tallennetusta ja transkriptoidusta stimulated recall -haastattelusta, joissa psykiatrit yhteisen tutkimisen haastattelun kuvanauhan avulla palauttivat mieleensä sisäistä keskusteluaan. Yhteisen tutkimisen haastattelu oli ryhmäkeskustelu, jossa oli lääkärien ohella läsnä potilas, hänen perheenjäseniään sekä muita ammattilaisia. Ensimmäisessä osatutkimuksessa kuvattiin tutkimusaineistoa kokonaisuudessaan ja keskityttiin psykiatrien työtovereita koskevaan sisäiseen keskusteluun. Toisessa osatutkimuksessa paneuduttiin psykiatrien kokemukseen toimijuudestaan....

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“…Sin embargo en la última década su aplicación en salud mental ha recibido especial atención (9,(63)(64)(65)(66). Se han señalado distintos argumentos para defender la utilidad del PDC en salud mental.…”

Section: La Decisión Compartida En Salud Mentalunclassified

“…A pesar de todo esto, el PDC está poco extendido en la práctica cotidiana de los servicios de salud mental (73-74) y, en los casos en que se aplica, suele hacerse de modo incompleto y reducido a los aspectos informativos (65).…”

Section: J M Villagrán I Lara F González-saizunclassified