Shared decision making in mental health care settings: Perspective, purpose and practice

Tse, Samson

doi:10.1002/wps.20417

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…Patients’ satisfaction with treatment seems to be more strongly linked to perceived coercion rather than to formal coercion, since perceived coercion is largely based on the overall experience of involuntary treatments and on modalities of treatment negotiation with patients. Good empathy, realistic and explicit communication would allow patients to feel more involved in decisions regarding their health (42), to improve patient-clinician relationship (43) and to promote patients’ recovery (44, 45). In particular, a shared approach in decision-making should be adopted in order to improve not only patients’ satisfaction with received treatments, but also patients’ adherence to treatments (46–49).…”

Section: Discussionmentioning

confidence: 99%

Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study

et al. 2019

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The decision to use coercive measures (restraint, seclusion and forced medication) in psychiatric practice is controversial in mental health care. The EUNOMIA study was funded by the European Commission and carried out in 11 countries in order to develop European recommendations for good clinical practice on the use of coercive measures. The aim of the study is to identify sociodemographic and clinical predictors of the levels of perceived coercion in a sample of Italian patients with severe mental disorders at hospital admission. A total of 294 patients were recruited in five Italian psychiatric hospitals and screened with the MacArthur Perceived Coercion Scale to explore the levels of perceived coercion. Patients were assessed three times: within the first seven days after admission as well as after 1 and 3 months. At each time point, data on changes of perceived coercion, assessed by the Cantril Ladder of Perceived Coercion Scale, information on coercive measures received during hospitalization and the levels of satisfaction with the received treatments were collected. According to the multivariable regression model, being compulsorily admitted (OR: 2.5; 95% CI: 1.3–3.3, p < .000), being male (OR: 0.7; 95% CI: 0.9-1.4; p < .01), being older (OR: 0.03; 95% CI: 0.01–0.06) and less satisfied with received treatments (OR: -0.2; 95% CI: -0.3 to -0.1; p < .05) are all associated with higher levels of perceived coercion, even after controlling for the use of any coercive measure during hospitalization. Satisfaction with received treatment predicts the levels of perceived coercion and this should represent an important challenge for mental health professionals.

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Section: Discussionmentioning

confidence: 99%

Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study

et al. 2019

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“…Some research suggests that SDM does not require the use of a physical decision aid to be effective. 38 Other studies have suggested that decision aids may promote SDM, 39 and decision aids have been recommended by Elwyn et al 1 to facilitate evidence-based decision-making when engaging in SDM.…”

Section: Methodsmentioning

confidence: 99%

The impact of shared decision-making on the treatment of anxiety and depressive disorders: systematic review

et al. 2021

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Background Shared decision-making encourages patients to explore treatment options/choices in collaboration with their healthcare provider, inclusive of the best available evidence and the patient's values/preferences. Several effective treatments exist for people with anxiety and/or depressive disorders; shared decision-making may be particularly useful in this context. Aims To investigate whether shared decision-making enhances clinical outcomes in adults with anxiety and/or depressive disorders. Method A systematic review was conducted. Five electronic health databases were searched from database inception until August 2019, in addition to reference lists of included studies. Prospective controlled studies of shared decision-making in adults (aged 18–64 years) diagnosed with an anxiety and/or depressive disorder were included. Two reviewers independently conducted each stage of the review process. Results Six randomised controlled trials (N = 1834 participants) were included. Patient satisfaction improved in four studies. Patients were more likely to receive adequate treatment for depression in three studies. Anxiety symptoms decreased in one study. Patient involvement in decision-making increased in three studies. Because of the lack of blinded interventions and outcome assessment, the included studies were at moderate risk of bias. The certainty of evidence ranged from low to moderate, per GRADE criteria. Conclusions Shared decision-making shows promise for enhancing quality-of-care outcomes such as patient satisfaction, without increasing consultation time. but appears unlikely to improve symptoms of depression. However, it appears to be understudied in patients with anxiety disorders. Heterogeneity regarding definition and measurement of shared decision-making posed challenges for interpreting the results. More research is recommended to advance the field.

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“…The above observed disparity may lead to explaining power relationships, dissatisfaction and most of all a resistance to culture change and organisations should not just see this as a problem but a potential open door for problem solving. Indeed, commitment from organizations and practitioners is key in transforming SDM from rhetoric into reality (Tse 2017 ) and increasing understanding of shared and supported decision making is an essential step in effective implementation (Lloyd et al 2013 ; May and Finch 2009 ). Moving forward, organisations are therefore required to think more carefully about how they communicate important information regarding the right of the individual to be part of the decision making process and the choices available to them as one size will not fit all.…”

Section: Discussionmentioning

confidence: 99%

“…SDM is considered the golden standard of modern healthcare provision (Tse 2017 ). The NHS Five Year Forward View set out a vision of a new relationship between people and professionals, and between the care system and communities (NHS 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?

Pappa

Barnett

Gomme

et al. 2021

Community Ment Health J

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Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide ‘Supported Decision Making in Medication’ Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber’s perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.

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Shared decision making in mental health care settings: Perspective, purpose and practice

Cited by 10 publications

References 5 publications

Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study

Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study

The impact of shared decision-making on the treatment of anxiety and depressive disorders: systematic review

Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?

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