Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators

Ashoorian, Deena; Davidson, Rowan

doi:10.1007/s11096-021-01240-3

Cited by 11 publications

(13 citation statements)

References 29 publications

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“… 66 Decisions aids based on evidence are designed to assist patients in preparing for decision‐making by weighing the trade‐offs of treatment options. 4 Our findings show that although Decision Aids help patients enhance medical knowledge and identify their priorities, they should still be supported with information by Decision Aids consistent with patients' developmental stage and literacy level.…”

Section: Discussionmentioning

confidence: 62%

“…It requires a significant amount of time for the physician to implement SDM effectively, while the time invested by physicians in SDM is only the ‘tip of the iceberg’. 4 , 43 , 56 , 57 …”

Section: Resultsmentioning

confidence: 99%

“…Charles et al 3 stated that SDM involved at least two participants, the physician and the patient, and further elaborated that SDM included the following characteristic elements: starting with the physicians' medical diagnosis for the patient, followed by a thorough discussion between the physician and the patient, including clarification of each treatment option, analysis of benefits and harms, and patient preferences, and then ending with a physician–patient shared treatment decision. Although the latest studies have incorporated the diagnoses and opinions of nurses and pharmacists into the process of SDM, the view of Charles et al 3 is still well accepted and practiced 4 . We must emphasize that physicians' medical diagnosis and treatment decisions are an indispensable part of SDM.…”

Section: Introductionmentioning

confidence: 99%

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Exploring motivations and resistances for implementing shared decision‐making in clinical practice: A systematic review based on a structure–process–outcome model

Tang

Wang

2022

Health Expectations

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Objective: Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM.Methods: A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model.Results: From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome.The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension.Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. Conclusions:The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low-and middle-income countries. Furthermore, we consider it important to

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Section: Discussionmentioning

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring motivations and resistances for implementing shared decision‐making in clinical practice: A systematic review based on a structure–process–outcome model

Tang

Wang

2022

Health Expectations

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“…Barriers to this SDM practice being followed against patients' role preferences should be investigated, and intervention should occur. One recent review summarized that the barriers to SDM for psychiatric medication management were due to patients' lack of confidence and awareness of their rights, limited access to information, poor communication by all parties or either party, and misperceptions about patients' decision-making abilities ( 61 ). The most commonly identified barriers were the assumption of hierarchical doctor–patient relationships and the paternalistic views of decision-making in the culture.…”

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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“…that patients’ views should guide all clinical decision making [ 11 , 12 ]. These are all key elements of the recovery process, and thus SDM reflects the values of recovery-oriented mental health care [ 13 ] and is a central part of the recovery process [ 14 , 15 ]. A recent study also indicates that SDM may improve personal recovery [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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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Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators

Cited by 11 publications

References 29 publications

Exploring motivations and resistances for implementing shared decision‐making in clinical practice: A systematic review based on a structure–process–outcome model

Exploring motivations and resistances for implementing shared decision‐making in clinical practice: A systematic review based on a structure–process–outcome model

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

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

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