What is the process by which a decision to administer electroconvulsive therapy (ECT) or not is made? A grounded theory informed study of the multi-disciplinary professionals involved

Abstract

PurposeTo develop a grounded theory-informed model explaining the decision-making process professionals in multi-disciplinary teams go through in deciding whether to administer electroconvulsive therapy (ECT) or not.MethodsA grounded theory informed methodology was used to analyse the data offered by ten participants who had all been involved in the process of deciding if someone has ECT or not.ResultsThe core categories, described as ‘layers’ in this research, ‘personal and professional identity’; ‘subjective vs objective’; ‘Guidelines or Clinical Instinct?’; ‘Someone has to take Responsibility’ and ‘the decision in action’, were constructed from the data.ConclusionsThe study describes a useful insight into the layers of the decision-making process that could be further considered in clinical settings. The model highlights the decision to give ECT that has many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process. The consultant psychiatrist and the patient were seen as holding most power in the process depending on whether the Mental Capacity Act (2005) or Mental Health Act (2007) was being followed. Patients were seen to experience a very different decision-making process dependant on the personal views of the professionals in relation to ECT.

What are the ethical dilemmas in the decision‐making processes of nursing people given electroconvulsive therapy? A critical realist review of qualitative evidence

“…Frustration by MHNs and other clinicians at the continued portrayal of ECT in media in a manner which is considered as outdated and playing to negative stereotypes and contributing to the stigma around the procedure was noted; it was felt that this may unduly influence MHNs and potential recipients in deciding whether to use the treatment, as well as their experience of it (Duxbury et al, 2018; Hersh, 2013; Seniuk, 2018; Torrance, 2015).…”

“…The idea of shared decision‐making as part of the process within the multi‐disciplinary team (MDT) and the disparity in perceptions of this process between professionals was evident. The decision to administer ECT was that of the psychiatrist as responsible clinician, with psychiatrists expressing the belief that the rest of the team agreed with the decision made (Clarke et al, 2018), while other evidence suggested this was not the feeling of the whole team (Duxbury et al, 2018) and that MHN felt it better to keep their opinions to themselves to avoid disputes within the team (Flanigan, 2010).…”

The Quality of Informed Consent Obtaining Before Electroconvulsive Therapy: A Report From a Referral, Academic Hospital

“…However, a few studies believe that in these conditions, a team discussion and decision might be preferred. In Duxbury et al study, some patients declare that ECT administration should be wholly decided by clinicians, and there is no need to involve non-medics [21]. Unlike this opinion, some other studies indicate that patients' right to choose ECT must be seriously respected.…”

Mental health professionals’ attitudes toward and knowledge about electroconvulsive therapy at Weskoppies Hospital, South Africa

“…Patients with complex psychiatric disorders in psychiatric hospitals are treated by different members of the multidisciplinary team, which may include nursing staff, psychiatrists, psychologists, occupational therapists, and social workers. A study by Duxbury et al examined the decision‐making process professionals in multidisciplinary teams go through in deciding whether to administer ECT or not. In the study, Duxbury et al found that decision to give ECT that has many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process.…”

“…In the study, Duxbury et al found that decision to give ECT that has many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process. Although the consultant psychiatrist and the patient have the most decision‐making power with regard to the administration of ECT, other members of the multi‐disciplinary team are involved. When ECT is prescribed for a patient, the patient may consult other members of the multidisciplinary team to make a more informed choice.…”