Mental health professionals' experiences with shared decision-making for patients with psychotic disorders: a qualitative study

Espen W Haugom, Bjørn Stensrud, Gro Beston, Torleif Ruud, Anne S Landheim, Espen W Haugom, Bjørn Stensrud, Gro Beston, Torleif Ruud, Anne S Landheim

Abstract

Background: Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient's preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals' experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals' SDM experiences with patients with psychotic disorders.

Methods: Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis.

Results: Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them.

Conclusion: Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.

Keywords: Mental health care; Mental health professionals; Psychotic disorders; Shared decision-making.

Conflict of interest statement

Torleif Ruud is an Editorial Board Member for BMC Health Services Research. The authors declare that they have no further competing interests.

References

    1. Coulter A, Collins A. Making shared decision-making a reality: no decision about me, without me. London: King’s Fund; 2011.
    1. Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60:301–312. doi: 10.1016/j.pec.2005.06.010.
    1. Slade M. Implementing shared decision making in routine mental health care. World Psychiatry. 2017;16:146–153. doi: 10.1002/wps.20412.
    1. Hamann J, Heres S. Adapting shared decision making for individuals with severe mental illness. Psychiatr Serv. 2014;65:1483–1486. doi: 10.1176/appi.ps.201400307.
    1. Helse- og omsorgsdepartementet [Norwegian Ministry of Health and Care Services] Nasjonal helse- og sykehusplan [National health and hospital plan] (2016–2019). Meld St 11 (2015–2016) Oslo: Helse- og omsorgsdepartementet; 2015.
    1. Omeni E, Barnes M, MacDonald D, Crawford M, Rose D. Service user involvement: impact and participation: a survey of service user and staff perspectives. BMC Health Serv Res. 2014;14:491. doi: 10.1186/s12913-014-0491-7.
    1. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango) Soc Sci Med. 1997;44:681–692. doi: 10.1016/S0277-9536(96)00221-3.
    1. Adams JR, Drake RE, Wolford GL. Shared decision-making preferences of people with severe mental illness. Psychiatr Serv. 2007;58:1219–1221. doi: 10.1176/ps.2007.58.9.1219.
    1. Dahlqvist Jonsson P, Schon UK, Rosenberg D, Sandlund M, Svedberg P. Service users’ experiences of participation in decision making in mental health services. J Psychiatr Ment Health Nurs. 2015;22:688–697. doi: 10.1111/jpm.12246.
    1. Stensrud B, Hoyer G, Granerud A, Landheim AS. “Life on hold”: a qualitative study of patient experiences with outpatient commitment in two Norwegian counties. Issues Ment Health Nurs. 2015;36:209–216. doi: 10.3109/01612840.2014.955933.
    1. De las Cuevas C, Penate W. To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio-demographic, clinical, and psychological variables. Acta Neuropsychiatr. 2014;26:372–381. doi: 10.1017/neu.2014.21.
    1. Beitinger R, Kissling W, Hamann J. Trends and perspectives of shared decision-making in schizophrenia and related disorders. Curr Opin Psychiatry. 2014;27:222–229. doi: 10.1097/YCO.0000000000000057.
    1. Hamann J, Mendel R, Cohen R, Heres S, Ziegler M, Buhner M, et al. Psychiatrists’ use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics. Psychiatr Serv. 2009;60:1107–1112. doi: 10.1176/ps.2009.60.8.1107.
    1. Seale C, Chaplin R, Lelliott P, Quirk A. Sharing decisions in consultations involving anti-psychotic medication: a qualitative study of psychiatrists’ experiences. Soc Sci Med. 2006;62:2861–2873. doi: 10.1016/j.socscimed.2005.11.002.
    1. Shepherd A, Shorthouse O, Gask L. Consultant psychiatrists’ experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study. BMC Psychiatry. 2014;14:127. doi: 10.1186/1471-244X-14-127.
    1. Psykisk helsevernloven . The Norwegian Mental Health Act. 1999.
    1. Grisso T, Appelbaum P. Assessing competence to consent to treatment. A guide for physicians and other health professionals. New York: Oxford University Press; 1998.
    1. Pasient-og brukerrettighetsloven . The Norwegian Patient Rights Act. 1999.
    1. Kasper J, Lager AR, Rumpsfeld M, Kienlin S, Smestad KH, Brathen T, et al. Status report from Norway: implementation of patient involvement in Norwegian health care. Z Evid Fortbild Qual Gesundhwes. 2017;123–124:75–80. doi: 10.1016/j.zefq.2017.05.015.
    1. The National Health Portal [Internet]. (2019). Available from: . Accessed 18 September 2019.
    1. Helse- og omsorgsdepartementet [Norwegian Ministry of Health and Care Services] Oppdragsdokument for 2015 [Assignment letter for 2015 to the Regional Health Authorities] Oslo: Helse- og omsorgsdepartementet; 2015.
    1. Brink PJ, Wood MJ. Advanced design in nursing research. Thousand Oaks, CA: Sage Publications; 1997.
    1. Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today. 2017;56:29–34. doi: 10.1016/j.nedt.2017.06.002.
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier: Implementation of National Guidelines for Treatment of Psychoses; 2017. Available from: . Accessed 5 Feb 2020.
    1. Ruud T, Drivenes K, Drake RE, Haaland VO, Landers M, Stensrud B, et al. The antipsychotic medication management Fidelity scale: psychometric properties. Admin Pol Ment Health. 2020. 10.1007/s10488-020-01018-1.
    1. Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995;311:299–302. doi: 10.1136/bmj.311.7000.299.
    1. Veseth M, Binder PE, Borg M, Davidson L. Collaborating to stay open and aware: service user involvement in mental health research as an aid in reflexivity. Nord Psychol. 2017;69:256–263. doi: 10.1080/19012276.2017.1282324.
    1. Legare F, Thompson-Leduc P. Twelve myths about shared decision making. Patient Educ Couns. 2014;96:281–286. doi: 10.1016/j.pec.2014.06.014.
    1. National Institute for Health and Care Excellence . Psychosis and schizophrenia in adults: prevention and management [Internet] London: NICE; 2014.
    1. Drake RE, Deegan PE. Shared decision making is an ethical imperative. Psychiatr Serv. 2009;60:1007. doi: 10.1176/ps.2009.60.8.1007.
    1. Legare F, Ratte S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73:526–535. doi: 10.1016/j.pec.2008.07.018.
    1. Duncan E, Best C, Hagen S. Shared decision making interventions for people with mental health conditions. Cochrane Database Syst Rev. 2010:CD007297.
    1. Deegan PE. A web application to support recovery and shared decision making in psychiatric medication clinics. Psychiatr Rehabil J. 2010;34:23–28. doi: 10.2975/34.1.2010.23.28.
    1. Truglio-Londrigan M, Slyer JT, Singleton JK, Worral P. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Libr Syst Rev. 2012;10:4633–4646.
    1. Jeste DV, Depp CA, Palmer BW. Magnitude of impairment in decisional capacity in people with schizophrenia compared to normal subjects: an overview. Schizophr Bull. 2006;32:121–128. doi: 10.1093/schbul/sbj001.
    1. Ruissen AM, Widdershoven GA, Meynen G, Abma TA, van Balkom AJ. A systematic review of the literature about competence and poor insight. Acta Psychiatr Scand. 2012;125:103–113. doi: 10.1111/j.1600-0447.2011.01760.x.
    1. Cote-Arsenault D, Morrison-Beedy D. Practical advice for planning and conducting focus groups. Nurs Res. 1999;48:280–283. doi: 10.1097/00006199-199909000-00009.
    1. Mjosund NH, Eriksson M, Espnes GA, Haaland-Overby M, Jensen SL, Norheim I, et al. Service user involvement enhanced the research quality in a study using interpretative phenomenological analysis - the power of multiple perspectives. J Adv Nurs. 2017;73:265–278. doi: 10.1111/jan.13093.

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