Attitudes towards shared decision making in mental health: a qualitative synthesis

Abstract

PurposeShared Decision Making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users' experiential knowledge, values and preferences.. This article reviews the existing literature pertaining to key stakeholders' attitudes towards SDM in mental health. It examines whether perceived barriers and facilitators differ by group (e.g. service user, psychiatrist, nurse, social worker) and includes views of what facilitates and hinders the process for service users and practitioners. MethodologyThis review adopts the principles of a qualitative research synthesis. A key word search of research published between 1990 and 2016 was undertaken. Qualitative, quantitative and mixed methods studies were included. Findings43 papers were included and several themes identified for service user and practitioner perspectives. Both practitioners and service users see SDM as an ethical imperative, and both groups highlight the need to be flexible in implementing shared decision making, suggesting it is context dependent. A range of challenges and barriers are presented by both practitioners and service users reflecting complex contextual and cultural features within which interactions in mental health take place. There were qualitative differences in what service users and practitioners describe as preventing or enabling SDM. The differences highlighted point towards different challenges and priorities in SDM for service users and practitioners. Originality / ValueThe presentation of nuanced views and attitudes that practitioners and service users hold represent an important and under reported area and offer insight into the reasons for the gap between idealised policy and actual practice of SDM in mental health settings.

Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse

“…After reading the DA, both patient and family were highly knowledgeable about treatment options and outcomes, based on current national guidelines on informed patient consent to medical interventions [ 46 ]. Namely, increased knowledge is one of the primary outcomes for assessing DA effectiveness [ 37 ], and has consistently been identified as enabling patient participation in decision-making and treatment uptake [ 66 ]. A majority of patients (65.5%) also made a decision that was congruent with their informed treatment values for medication, and half of patients (50%) for adjunctive psychological treatments, respectively).…”

The Place of Social Recovery in Mental Health and Related Services

“…All too often the full information about interventions is not given, or not given in a way that can be understood by the person, the provider presents their suggestions as the best available, and is not interested in the person’s views and preferences. Being treated as a person, rather than as a bundle of symptoms and problems, is presented by service users as the key condition to being ready to share with the provider their genuine thoughts and preferences [ 16 , 17 , 18 ]. Knowing that the provider has the power to lead to a compulsory admission, or/and use of constraints on a ward is a major factor in preventing people from sharing with the provider their genuine preferences [ 19 ].…”

Shared decision‐making in mental and behavioural health interventions

“…Although most patients prefer SDM, they may not actually expect SDM to be used in their care. Research indicates that expectations are based on past experiences, and given that SDM is a relatively newer model that is still infrequently used in the healthcare fields, patients may begin their treatment simply expecting that their mental health care provider will make all of the treatment decisions. Relatedly, many patients may underestimate the importance of their contributions to decisions or not know how to engage in the SDM process.…”

“…However, research indicates that for mental health concerns, SDM is often the exception rather than the rule. [6][7][8][9][10] In this paper, we discuss the research support for SDM within mental health care, explore barriers to its use, and provide recommendations for increasing SDM in mental health treatments.…”

“…Thus, shared decision‐making (SDM), which is a collaborative decision‐making process with equal patient and clinician involvement, would seem to have a natural home within mental health interventions. However, research indicates that for mental health concerns, SDM is often the exception rather than the rule . In this paper, we discuss the research support for SDM within mental health care, explore barriers to its use, and provide recommendations for increasing SDM in mental health treatments.…”