Shared Decision Making&lt;subtitle&gt;Have We Missed the Obvious?&lt;/subtitle&gt;

Hanson, Janice L.

doi:10.1001/archinte.168.13.1368

Cited by 50 publications

(33 citation statements)

References 16 publications

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“…Although this policy-practice gap may have explanatory value, we believe our data also reflect participants' subjugated understandings of the nature of communication, epistemic expertise and engagement in mental health services as well as their understandings of treatment expectations. These perspectives may point to challenges with the adoption of a simple linear model of decision-making and information exchange (see Hanson, 2008;Moreau et al, 2011). Moreover, such perspectives were not only expressed by clinicians but by clients as well, which is an important finding given that rhetoric often frames SDM as a transformation of practice that is unquestionably in favor of clients.…”

Section: Role Of Epistemic Expertise In Managing Informationmentioning

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: Role Of Epistemic Expertise In Managing Informationmentioning

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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“…Whatever definition and measure are used, however, SDM has not been found to be a frequent part of usual medical practice. [7][8][9] It may be particularly important to understand and improve the frequency of SDM for patients with depression who are seen in primary care. Although common in primary care, patients who receive depression treatment in this setting often do not receive the same quality of care that has been shown to be possible in effectiveness studies of depression treatment.…”

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confidence: 99%

How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

Solberg

Crain

Rubenstein

et al. 2014

The Journal of the American Board of Family Medicine

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Background: Shared decision making (SDM) is an important component of patient-centered care, but there is little information about its use in the primary care of depression, so we sought to study its frequency in usual care as reported by patients.Methods: Telephone interview of 1168 depressed patients taking antidepressants in 88 Minnesota primary care clinics who were identified from pharmacy claims data soon after a prescription for an antidepressant. We measured depression severity with the 9-item Patient Health Questionnaire and used a composite measure of SDM that reflected patient involvement in treatment decisions.Results: These patients reported an average score for SDM of 50.7 (standard deviation, 32.8) on a scale of 0 to 100, where higher scores equate with greater SDM. In univariate analyses, the largest differences among scores were for age (scores of 58, 53, 45, and 33 for those aged 18 -34, 35-49, 50 -64, and >64 years, respectively; P < .0001); duration of treatment (a score of 56.6 on treatment <6 weeks vs 45.5 if longer; P < .001); and other treatments in the past 6 months (60.5 if yes vs. 46.0 if no; P ‫؍‬ .001). SDM was not associated with any clinic characteristics, but it was correlated with patientreported quality of care (r ‫؍‬ 0.48; P < .001). Multivariate analyses confirmed some of these findings while showing a more complex set of relationships.Conclusions: Older patients with depression and those who have been in treatment longer report much less SDM in their care. Improving SDM, especially for these groups, may be an important target for improving patient experience and perceived quality.

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“…Sharing decision-making entails an interactive collaboration and mutual influence of the patient and the health professional [30]. To do this, health professionals should be focused on finding common ground with patients about their health problems.…”

Section: Sharing Decision-makingmentioning

confidence: 99%

Defining elements of patient-centered care for therapeutic relationships: a literature review of common themes

Clarke¹,

Ells²,

Thombs³

et al. 2017

EJPCH

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Rationale and aims: Patient-centered care is a recognized clinical method and ideal for patient -health professional relationships. Many definitions have influenced its evolution. For this research, our aim was: (1) to assess definitions and descriptions of patient-centered care to draw out elements of patient-centered care that are considered to be important markers of successful patient-centered care in the patient -health professional relationship and (2) to propose a set of elements that collectively reflect the diversity of 'patient-centered' definitions that describe the patient-professional relationship in this literature. A secondary aim was (3) to provide elements that could be used for development of a quality assessment tool. Methods: We conducted a critical interpretive review of patient-centered care and patient-centered communication literature, beginning with a critical synthesis that yielded 12 articles that introduced new theoretical and definitional work on patient-centered care and patient-centered communication. We used an inductive and iterative analysis process to identify and group common themes. We used operational language to describe these themes. Results: We identified 6 elements (each with 2 or more sub-elements) of the patient -health professional relationship that are considered important markers of successful patient-centered care (as found in this literature). The 6 elements are: (1) Engaging the Patient as a Whole Person, (2) Recognizing and Responding to Emotions, (3) Fostering a Therapeutic Alliance, (4) Promoting an Exchange of Information, (5) Sharing Decision-Making and (6) Enabling Continuity of Care, Self-Management and Patient Navigation. Conclusions: Comparable fundamental elements were common among most authors within this literature: we found that variation in theory was typically a matter of degree and language. This work contributes analyses towards greater theoretical consistency for conceptions of patient-centered care. It also provides avenues for future development of quality assurance benchmarks.

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Shared Decision Making<subtitle>Have We Missed the Obvious?</subtitle>

Cited by 50 publications

References 16 publications

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

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

How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

Defining elements of patient-centered care for therapeutic relationships: a literature review of common themes

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