What can patients do to facilitate shared decision making? A qualitative study of patients with depression or schizophrenia and psychiatrists

Hamann, Johannes; Kohl, Sarah; McCabe, Rose; Bühner, Markus; Mendel, Rosmarie; Albus, Margot; Bernd, J.

doi:10.1007/s00127-015-1089-z

Cited by 50 publications

(118 citation statements)

References 24 publications

(27 reference statements)

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“…This study identified patient-related barriers, such as symptoms, communicative difficulties, as well as clinician-related barriers, such as poor empathy and listening, and discounting patient concerns. In fact, no existing studies have explored the views and experiences of clinicians on the process of treatment decision-making in bipolar disorder , in contrast to several studies on depression (McMullen, 2012;Simmons, Hetrick, & Jorm, 2013) and schizophrenia (Farrelly et al, 2016;Hamann et al, 2015;Seale, Chaplin, Lelliott, & Quirk, 2006). However, this study did not ask specifically about treatment decision-making, and included only patient perspectives.…”

Section: Introductionmentioning

confidence: 99%

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Fisher

Manicavasagar

Sharpe

et al. 2018

Australian Psychologist

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Objective: Treatment decision-making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side-effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision-making, unmet patient needs for (b) decision-support and (c) information. Method: Qualitative semi-structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self-report professional experience, and clinician preferences for patient decision-making involvement were also assessed. Results: Qualitative analyses yielded two inter-related themes: (a) challenges and barriers to decision-making and (b) facilitators of clinician decision-making. Symptom severity, negative family attitudes, system-based factors, and information gaps were thought to pose challenges to decision-making. By contrast, decision-making was supported by patient information, family involvement and patient-centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist. Conclusions: Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision-making, active patient participation is hampered by unmet informational and decision-support needs. Current findings inform a number of bipolar II disorder-specific, clinician-endorsed strategies for facilitating patient decision-making, which can inform the development of targeted patient decisionsupport resources for use in this setting.

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Section: Introductionmentioning

confidence: 99%

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Fisher

Manicavasagar

Sharpe

et al. 2018

Australian Psychologist

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“…In this study we choose the most commonly used definition of patient participation, referring to patient involvement in decision making about their health care [10, 12]. This way, patient participation, which includes behaviours such as providing information, asking questions and preparing for consultations, is an issue closely related to Shared Decision Making (SDM) [13]. SDM is defined as a collaborative approach in which clinicians and patients share the best available information when making clinical decisions, and where patients are supported to consider options to achieve informed preferences [14].…”

Section: Introductionmentioning

confidence: 99%

“…Fostering patient engagement and SDM in mental health care is, therefore, essential. More initiatives are needed to support the decisional capacity, participation and active behaviour of patients in treatment granting them more choice and control regarding their own mental health care, to provide a more equitable and collaborative working relationship and to enhance shared decision making [1, 4, 13, 32]. …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that both the attitudes of clinicians and patients influence patient participation and joint decision making [8, 13, 30, 33–35]. The power imbalance between patients and clinicians is deemed to be a key barrier in making shared decisions [36].…”

Section: Introductionmentioning

confidence: 99%

“…Few initiatives targeting both patients’ and clinicians’ behaviour have been conducted and evaluated [33]. This underlines the need for new initiatives that aim to support patients as well as to modify clinicians’ attitudes [13, 35, 36]. …”

Section: Introductionmentioning

confidence: 99%

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A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial

et al. 2017

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BackgroundEnhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients’ and clinicians’ behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes.MethodsThis article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake.DiscussionThis study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment.Trial registrationTrial registration: Dutch Trial Register NTR5677. Registered 17th January 2016.

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Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments

Hasson‐Ohayon

Jong

Igra

et al. 2021

Clin Psychology and Psychoth

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Although the clinical significance of therapeutic alliance with people with psychosis is well established, the agreement between client and therapist assessments of therapeutic alliance and the longitudinal changes of both assessments have been rarely addressed. The current study examined client and therapist assessments of therapeutic alliance longitudinally and sought to determine whether insight and severity of symptoms moderated the degree to which therapist and client assessments were in agreement with one another. Forty‐five participants diagnosed with a schizophrenia spectrum disorder and their therapists were administered a therapeutic alliance questionnaire (Working Alliance Inventory‐Short Form) monthly for 6 months. Baseline symptoms were assessed using the PANSS. Results did not produce evidence that insight into illness moderated the relationship between agreement on the therapeutic alliance. However, symptoms of emotional discomfort at baseline predicted differences in agreement between clients and therapists on the relationship aspect of therapeutic alliance over the course of therapy. These results suggest that the ability to express symptoms of emotional discomfort may affect whether clients and therapists form similar appraisals of the strength of the therapeutic alliance.

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What can patients do to facilitate shared decision making? A qualitative study of patients with depression or schizophrenia and psychiatrists

Cited by 50 publications

References 24 publications

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial

Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments

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