Shared Decision-Making

Providing treatment to people with severe mental illnesses on an inpatient unit is fraught with challenges. Many patients are acutely ill and may be experiencing very severe symptoms that coexist with poor insight, emotional dysregulation, impulsivity, aggression, and severe disability. Moreover, many patients are involuntarily hospitalized and may be less cooperative with inpatient treatment. Some civilly committed patients may view their hospital tenure as needlessly lengthy and forced medications as impinging on their civil rights, while longing for less restrictive environments. For many practitioners, these are clinical challenges that adversely impact treatment adherence and ultimately positive treatment outcomes. There is accumulating evidence that the traditional model of decision making is insufficient in psychiatric care and may play a significant role in the reluctance of individuals who need mental health care to seek it and sustain their efforts in it. Shared decision-making, in contrast, provides a viable system of enhancing the engagement of care recipients in treatment and is an essential component of recovery-oriented practice. Inasmuch as it represents a change from the paternalistic model of traditional care, shared decision-making requires a shift in perspective and skill for both the provider and for the individual receiving mental health services. This chapter presents the concept of shared decision-making, explores provider attitudes, expectations and beliefs that may serve as barriers to its implementation, and provides practical strategies to facilitate effective shared decision-making in clinical care.

[1]  J. Baron,et al.  Thrombolytic therapy for acute stroke in the United Kingdom: experience from the safe implementation of thrombolysis in stroke (SITS) register. , 2008, QJM : monthly journal of the Association of Physicians.

[2]  Patrick W. Corrigan,et al.  Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma , 2005, European Psychiatry.

[3]  P Kinnersley,et al.  Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. , 2000, The British journal of general practice : the journal of the Royal College of General Practitioners.

[4]  Lisa M. Schwartz,et al.  PSYCHOLOGICAL SCIENCE IN THE PUBLIC INTEREST Helping Doctors and Patients Make Sense of Health Statistics , 2022 .

[5]  Karen R. Sepucha,et al.  Policy support for patient-centered care: the need for measurable improvements in decision quality. , 2004, Health affairs.

[6]  Margaret Holmes-Rovner,et al.  Patient comprehension of information for shared treatment decision making: state of the art and future directions. , 2003, Patient education and counseling.

[7]  Donald Berwick,et al.  My Right Knee , 2005, Annals of Internal Medicine.

[8]  R. Grol.  Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. , 2001, JAMA.

[9]  Glyn Elwyn,et al.  Evidence-based patient choice : inevitable or impossible? , 2001 .

[10]  M. Holmes-Rovner.  International collaboration in shared decision-making: the International Shared Decision Making (ISDM) conference history and prospects. , 2008, Patient education and counseling.

[11]  W Godolphin,et al.  Framework for teaching and learning informed shared decision making. , 1999, BMJ.

[12]  R. Drake,et al.  An update on randomized controlled trials of evidence-based supported employment. , 2008, Psychiatric rehabilitation journal.

[13]  R. Diamond.  Recovery from a psychiatrist's viewpoint. , 2006, Postgraduate medicine.

[14]  Gregory Makoul,et al.  An integrative model of shared decision making in medical encounters. , 2006, Patient education and counseling.

[15]  C. McKevitt,et al.  Assessing the promise of user involvement in health service development: ethnographic study , 2008, BMJ : British Medical Journal.

[16]  M. Lambert,et al.  Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort , 2010, Schizophrenia Research.

[17]  France Légaré,et al.  Establishing patient decision aids in primary care: update on the knowledge base. , 2008, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[18]  Trudy van der Weijden,et al.  Assessing the Quality of Decision Support Technologies Using the International Patient Decision Aid Standards instrument (IPDASi) , 2009, PloS one.

[19]  M. Tansella,et al.  What happens to patients seen only once by psychiatric services? Findings from a follow-up study , 2007, Psychiatry Research.

[20]  N. Tarrier,et al.  2‐COM: an instrument to facilitate patient–professional communication in routine clinical practice , 2002, Acta psychiatrica Scandinavica.

[21]  Karen R. Sepucha,et al.  An approach to measuring the quality of breast cancer decisions. , 2007, Patient education and counseling.

[22]  P. Buckley,et al.  Immersing Practitioners in the Recovery Model: An Educational Program Evaluation , 2009, Community Mental Health Journal.

[23]  Psychiatrists' use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics. , 2009 .

[24]  P. Buckley,et al.  Latent structure of psychotic experiences in the general population , 2012, Acta psychiatrica Scandinavica.

[25]  Andrew D. Oxman,et al.  The Effect of Alternative Summary Statistics for Communicating Risk Reduction on Decisions about Taking Statins: A Randomized Trial , 2009, PLoS medicine.

[26]  Angela Coulter,et al.  Full engagement in health , 2004, BMJ : British Medical Journal.

[27]  E. Guadagnoli,et al.  Patient participation in decision-making. , 1998, Social science & medicine.

[28]  J. Sloan,et al.  Decision making during serious illness: what role do patients really want to play? , 1992, Journal of clinical epidemiology.

[29]  Niall Turner,et al.  First-episode psychosis and disengagement from treatment: a systematic review. , 2014, Psychiatric services.

[30]  Trudy van der Weijden,et al.  Translating shared decision-making into health care clinical practices: Proof of concepts , 2008, Implementation science : IS.

[31]  G. Elwyn,et al.  The assessment of depressive patients' involvement in decision making in audio-taped primary care consultations. , 2006, Patient education and counseling.

[32]  M. Kaste,et al.  Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. , 2008, The New England journal of medicine.

[33]  K. Wallston,et al.  Compliance to health recommendations: a theoretical overview of message framing , 1988 .

[34]  G. Gordon,et al.  Physician expressions of uncertainty during patient encounters. , 2000, Patient education and counseling.

[35]  R. Thomson,et al.  Tensions in public health policy: patient engagement, evidence-based public health and health inequalities , 2005, Quality and Safety in Health Care.

[36]  A Gafni,et al.  The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model. , 1998, Social science & medicine.

[37]  I. Lipkus.  Numeric, Verbal, and Visual Formats of Conveying Health Risks: Suggested Best Practices and Future Recommendations , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[38]  L. Dixon,et al.  Assessing recovery of people with serious mental illness: development of a new scale. , 2012, Psychiatric services.

[39]  M. Schapira,et al.  The Influence of Graphic Format on Breast Cancer Risk Communication , 2006, Journal of health communication.

[40]  P. van Schaik,et al.  The utility of a multimedia education program for prostate cancer patients: a formative evaluation , 2004, British Journal of Cancer.

[41]  Glyn Elwyn,et al.  Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. , 2004, Family practice.

[42]  B. Ivarsson,et al.  Integrated care in schizophrenia: a 2‐year randomized controlled study of two community‐based treatment programs , 2003, Acta psychiatrica Scandinavica.

[43]  Robert E Drake,et al.  Shared decision making and medication management in the recovery process. , 2006, Psychiatric services.

[44]  M. Härter,et al.  Shared decision-making in diverse health care systems--translating research into practice. , 2008, Patient education and counseling.

[45]  Wilmar B. Schaufeli,et al.  The Burnout Companion to Study and Practice: A Critical Analysis , 1998 .

[46]  France Légaré,et al.  Coaching to support patients in making decisions , 2008, BMJ : British Medical Journal.

[47]  Glyn Elwyn,et al.  Are Patient Decision Aids the Best Way to Improve Clinical Decision Making? Report of the IPDAS Symposium , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[48]  A. Barratt,et al.  Integrated decision making: definitions for a new discipline. , 2003, Patient education and counseling.

[49]  G. Elwyn,et al.  Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol , 2008, BMC health services research.

[50]  Maureen A Smith,et al.  A typology of preferences for participation in healthcare decision making. , 2006, Social science & medicine.

[51]  Patricia E Deegan,et al.  Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. , 2008, Psychiatric services.

[52]  Lars Hansson,et al.  Structured patient–clinician communication and 1-year outcome in community mental healthcare , 2007, British Journal of Psychiatry.

[53]  R. Thomson,et al.  Patients' preference for involvement in medical decision making: a narrative review. , 2006, Patient education and counseling.

[54]  M. Roca,et al.  Partial adherence to antipsychotic medication impacts the course of illness in patients with schizophrenia: a review. , 2009, Primary care companion to the Journal of clinical psychiatry.

[55]  Edward C. Jones,et al.  Patients’ Expectations of Knee Surgery , 2001, The Journal of bone and joint surgery. American volume.

[56]  France Légaré,et al.  Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. , 2008, Patient education and counseling.

[57]  R. Drake,et al.  Shared decision making is an ethical imperative. , 2009, Psychiatric services.

[58]  J. Hibbard,et al.  Engaging Health Care Consumers to Improve the Quality of Care , 2003, Medical care.

[59]  W. Levinson,et al.  Not all patients want to participate in decision making , 2005, Journal of General Internal Medicine.

[60]  Consumer involvement—a vital piece of the quality quilt: the California HealthCare Foundation's strategy for engaging California consumers , 2002, Quality & safety in health care.

[61]  William Godolphin,et al.  Putting informed and shared decision making into practice , 2006, Health expectations : an international journal of public participation in health care and health policy.

[62]  J. Benbassat,et al.  Patients' preferences for participation in clinical decision making: a review of published surveys. , 1998, Behavioral medicine.

[63]  M. Brunette,et al.  Recovery-oriented psychopharmacology: redefining the goals of antipsychotic treatment. , 2000, The Journal of clinical psychiatry.

[64]  J. Saver.  Time Is Brain—Quantified , 2006, Stroke.

[65]  S. Leucht,et al.  Shared decision making and long-term outcome in schizophrenia treatment. , 2007, The Journal of clinical psychiatry.

[66]  Glyn Elwyn,et al.  Patient-based outcome results from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. , 2004, Family practice.

[67]  Marianne Schmid Mast,et al.  Concordance between physician communication style and patient attitudes predicts patient satisfaction. , 2012, Patient education and counseling.

[68]  Nancy Kraetschmer,et al.  Do people want to be autonomous patients? Preferred roles in treatment decision‐making in several patient populations , 2007, Health expectations : an international journal of public participation in health care and health policy.

[69]  G. Elwyn,et al.  Where is the theory? Evaluating the theoretical frameworks described in decision support technologies. , 2008, Patient education and counseling.

[70]  S. Collins.  Patient Participation in Health Care Consultations: Qualitative Perspectives , 2007 .

[71]  S. Leucht,et al.  Shared decision making for in‐patients with schizophrenia , 2006, Acta psychiatrica Scandinavica.

[72]  M. Angermeyer,et al.  The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder , 2003, Acta psychiatrica Scandinavica.

[73]  W. Godolphin.  The role of risk communication in shared decision making , 2003, BMJ : British Medical Journal.

[74]  Martin Härter,et al.  The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. , 2010, Patient education and counseling.

[75]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[76]  S. Priebe,et al.  Processes of disengagement and engagement in assertive outreach patients: qualitative study , 2005, British Journal of Psychiatry.

[77]  W S Fenton,et al.  Determinants of medication compliance in schizophrenia: empirical and clinical findings. , 1997, Schizophrenia bulletin.

[78]  Werner Kissling,et al.  Patient participation in antipsychotic drug choice decisions , 2010, Psychiatry Research.

[79]  Gerd Gigerenzer,et al.  Communicating Statistical Information , 2000, Science.

[80]  M. Murray,et al.  Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy. , 2008, Worldviews on evidence-based nursing.

[81]  F. Légaré,et al.  Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions , 2006, Implementation science : IS.

[82]  D. Liebeskind,et al.  Assessment and Improvement of Figures to Visually Convey Benefit and Risk of Stroke Thrombolysis , 2010, Stroke.

[83]  R. McKendry,et al.  Challenges in family practice related to informed and shared decision-making: a survey of preceptors of medical students. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[84]  B. Rimer,et al.  Informed decision making: What is its role in cancer screening? , 2004, Cancer.

[85]  Aileen O'Brien,et al.  Disengagement from mental health services , 2009, Social Psychiatry and Psychiatric Epidemiology.

[86]  B. Lo,et al.  Do patients want to participate in medical decision making? , 1984, JAMA.

[87]  Hans Förstl,et al.  Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. , 2014, JAMA psychiatry.

[88]  Christina Maslach,et al.  Burnout: The Cost of Caring , 1982 .

[89]  L. Davidson,et al.  The Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery. , 2006, Psychiatric rehabilitation journal.

[90]  Lu Liu,et al.  Predictors of disengagement from treatment in an early psychosis program , 2012, Schizophrenia Research.

[91]  A Coulter,et al.  Sharing decisions with patients: is the information good enough? , 1999, BMJ.

[92]  S. Normand,et al.  Evaluation of a Patient Activation and Empowerment Intervention in Mental Health Care , 2008, Medical care.

[93]  A. Ciccone.  Consent to thrombolysis in acute ischaemic stroke: from trial to practice , 2003, The Lancet Neurology.

[94]  M. Koopmanschap,et al.  Measuring shared decision making processes in psychiatry: skills versus patient satisfaction. , 2007, Patient education and counseling.

[95]  Stacey L. Sheridan,et al.  Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making , 2005, Annals of Internal Medicine.

[96]  Anita Everett,et al.  Promoting the value and practice of shared decision-making in mental health care. , 2007, Psychiatric rehabilitation journal.

[97]  Juni Palmgren,et al.  A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. , 2002, The New England journal of medicine.

[98]  Bruce G. Link,et al.  The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample , 2009, Social Psychiatry and Psychiatric Epidemiology.

[99]  Mike Slade,et al.  Determinants, self-management strategies and interventions for hope in people with mental disorders: systematic search and narrative review. , 2012, Social science & medicine.

[100]  Judith Covey,et al.  A Meta-analysis of the Effects of Presenting Treatment Benefits in Different Formats , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[101]  R. Kravitz,et al.  Patient Participation in Medical Consultations: Why Some Patients are More Involved Than Others , 2005, Medical care.

[102]  P. Buckley.  PRINCIPLES AND PRACTICES OF MEDICATION MANAGEMENT FOR PEOPLE WITH SCHIZOPHRENIA Evolution within a Recovery-Based Framework of Care , 2012 .

[103]  A. Lang.  Mental Health Treatment Preferences of Primary Care Patients , 2005, Journal of Behavioral Medicine.

[104]  J. Brown.  Patient-centred medicine: Transforming the clinical method , 1998 .

[105]  M. Valenstein,et al.  Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. , 2004, Schizophrenia bulletin.

[106]  James N Weinstein,et al.  Extending the P4P agenda, part 1: how Medicare can improve patient decision making and reduce unnecessary care. , 2007, Health affairs.

[107]  Julie Kreyenbuhl,et al.  Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. , 2009, Schizophrenia bulletin.

[108]  B. Kuehn.  States explore shared decision making. , 2009, JAMA.

[109]  P W Corrigan,et al.  Three strategies for changing attributions about severe mental illness. , 2001, Schizophrenia bulletin.

[110]  V. Entwistle,et al.  Patient involvement in treatment decision-making: the case for a broader conceptual framework. , 2006, Patient education and counseling.

[111]  W. Weston,et al.  Informed and shared decision-making: the crux of patient-centered care. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[112]  William Godolphin,et al.  Doctor-patient communications in the Aboriginal community: towards the development of educational programs. , 2006, Patient education and counseling.

[113]  A. Tversky,et al.  The framing of decisions and the psychology of choice. , 1981, Science.

[114]  A. O'Connor,et al.  Using patient decision aids to promote evidence-based decision making , 2001, ACP journal club.

[115]  Amiram Gafni,et al.  What do we mean by partnership in making decisions about treatment? , 1999, BMJ.

[116]  P. Svedberg,et al.  Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? , 2013, The International journal of social psychiatry.

[117]  D. Henry,et al.  Describing treatment effects to patients , 2003, Journal of General Internal Medicine.

[118]  R. Drake,et al.  Shared Decision Making in Antipsychotic Management , 2008, Journal of psychiatric practice.

[119]  H. Llewellyn-Thomas,et al.  Patients' Health-care Decision Making , 1995, Medical decision making : an international journal of the Society for Medical Decision Making.

[120]  A. Mulley.  The need to confront variation in practice , 2009 .

[121]  J P Kassirer,et al.  Incorporating patients' preferences into medical decisions. , 1994, The New England journal of medicine.

[122]  C. Charles,et al.  Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). , 1997, Social science & medicine.

[123]  T. Kendrick,et al.  The primary care of patients with schizophrenia: a search for good practice. , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.

[124]  P. Ubel,et al.  The impact of the format of graphical presentation on health-related knowledge and treatment choices. , 2008, Patient education and counseling.

[125]  Aileen Clarke,et al.  Developing a quality criteria framework for patient decision aids: online international Delphi consensus process , 2006, BMJ : British Medical Journal.

[126]  William Godolphin,et al.  Shared decision-making. , 2009, Healthcare quarterly.

[127]  G Schlaug,et al.  The HAT Score , 2008, Neurology.

[128]  T. Sharma,et al.  What attitudes do psychiatrists hold towards people with mental illness , 2004 .

[129]  Mark Helfand.  Shared Decision Making, Decision Aids, and Risk Communication , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[130]  B. Jones,et al.  Characteristics of clients with schizophrenia who express certainty or uncertainty about continuing treatment with depot neuroleptic medication. , 1997, Archives of psychiatric nursing.

[131]  Jessica S. Ancker,et al.  The Practice of Informatics: Design Features of Graphs in Health Risk Communication: A Systematic Review , 2006, J. Am. Medical Informatics Assoc..

[132]  B. Schulze.  Stigma and mental health professionals: A review of the evidence on an intricate relationship , 2007, International review of psychiatry.

[133]  James G. Dolan,et al.  Risk communication formats for low probability events: an exploratory study of patient preferences , 2008, BMC Medical Informatics Decis. Mak..

[134]  Robert E. Drake,et al.  Shared Decision-Making and Evidence-Based Practice , 2006, Community Mental Health Journal.

[135]  Angela Robinson,et al.  Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools , 2001 .

[136]  Sapana R. Patel,et al.  Recent advances in shared decision making for mental health , 2008, Current opinion in psychiatry.

[137]  Richard Thomson,et al.  Risk communication in the clinical consultation. , 2005, Clinical medicine.

[138]  M. Wirtz,et al.  Development and first validation of the shared decision-making questionnaire (SDM-Q). , 2006, Patient education and counseling.

[139]  V. Wiseman,et al.  Involving the general public in priority setting: experiences from Australia. , 2003, Social science & medicine.

[140]  V. Entwistle,et al.  Decision aids for patients facing health treatment or screening decisions: systematic review , 1999, BMJ.

[141]  Catherine Best,et al.  Shared decision making interventions for people with mental health conditions. , 2010, The Cochrane database of systematic reviews.

[142]  Dawn Stacey,et al.  Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing , 2006, Implementation science : IS.

[143]  W. Rössler,et al.  Attitudes of mental health professionals toward people with schizophrenia and major depression. , 2005, Schizophrenia bulletin.

[144]  A. Barratt,et al.  Evidence Based Medicine and Shared Decision Making: the challenge of getting both evidence and preferences into health care. , 2008, Patient education and counseling.

[145]  Karen R. Sepucha,et al.  Toward the 'tipping point': decision aids and informed patient choice. , 2007, Health affairs.

[146]  James G Wright,et al.  Perceptions of, and willingness to consider, total joint arthroplasty in a population-based cohort of individuals with disabling hip and knee arthritis. , 2004, Arthritis and rheumatism.

[147]  P. Buckley,et al.  A psychometric study of recovery among Certified Peer Specialists , 2013, Psychiatry Research.

[148]  France Légaré,et al.  Risk communication in practice: the contribution of decision aids , 2003, BMJ : British Medical Journal.

[149]  M. Robin DiMatteo,et al.  Patient Adherence and Medical Treatment Outcomes: A Meta-Analysis , 2002, Medical care.

[150]  R. Drake,et al.  Shared decision-making preferences of people with severe mental illness. , 2007, Psychiatric services.

[151]  L. Roberts,et al.  Caring for “Difficult” Patients , 2003 .

[152]  I D Graham,et al.  The Ottawa patient decision aids. , 1999, Effective clinical practice : ECP.

[153]  Jessica L Walton,et al.  Changing Stigmatizing Perceptions and Recollections About Mental Illness: The Effects of NAMI’s In Our Own Voice , 2010, Community Mental Health Journal.

[154]  S. Michie,et al.  Are interventions theory-based? Development of a theory coding scheme. , 2010, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[155]  Hana Kajnar,et al.  Shared Decision Making in Medicine , 2006 .