Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework

Abstract

Shared decision making (SDM) is increasingly being suggested as an integral part of mental health provision. Yet, there is little research on what clinicians believe the barriers and facilitators around practice to be. At the same time, there is also increasing recognition of a theory-practice gap within the field, with calls for more pragmatic uses of theory to inform and improve clinical practice. Using the Theoretical Domains Framework (TDF), a comprehensive, theoretical-led framework, underpinned by 33 behaviour change theories and 128 constructs, clinician perceived barriers and facilitators to SDM are investigated. The sample comprised of 15 clinicians across two sites in England, who took part in qualitative semi-structured interviews and focus groups. Transcripts were analysed using a deductive thematic analysis, and themes were coded under each theoretical domain. Overall, 21 barriers and facilitators for SDM in child and youth mental health were identified across ten domains of the TDF. Under capability, barriers and facilitators were found for knowledge, skills, memory/attention/decision making processes, and behavioural regulation. For opportunity, barriers and facilitators were found for social influences, as well as environmental context and resources. Finally, for motivation, domains covered included: beliefs about consequences, beliefs about capabilities, emotions, and professional role and identity. Findings suggest that a range of barriers and facilitators affect clinicians' abilities to engage in SDM with young people and parents. Interventions which target different domains related to capability, opportunity and motivation should be developed to better facilitate young people and their families in care and treatment decisions.

Barriers and facilitators to shared decision‐making in child and youth mental health: Exploring young person and parent perspectives using the Theoretical Domains Framework

“…One explanation for this could be that SDM helps create ‘buy in’ through the process of co‐creation around treatment and values. This replicates findings exploring barriers and facilitators to SDM using the TDF with clinicians (Hayes et al, ). Whether young people have the capacity to be involved in decision‐making has been previously discussed (Coppock, ; Ruhe, Wangmo, Badarau, Elger, & Niggli, ).…”

“…Potentially choosing the ‘wrong’ option was highlighted as a negative consequence of SDM, as it had the potential to impede recovery or make symptoms worse. This theme has been highlighted previously when exploring barriers and facilitators of SDM using the TDF (Hayes et al, ). In the previous study, a clinician spoke of choosing the wrong option in relation to anxiety disorders and exposure experiments, which they felt patients would not do for short‐term relief.…”

“…Listening skills have also been highlighted in previous studies as a facilitator to decision‐making when they are present, and a barrier when they are absent (Offord et al, ; Pycroft et al, ). Potential reasons for this lack of listening skills have been discussed in previous studies, whereby the clinicians described feeling overextended as they needed to complete a number of tasks prior to the appointment ending (Hayes et al, ).…”

“…The TDF may have advantages over the ODSF (O'Connor, ) as it is validated (Cane et al, ) and widely used to design behaviour change interventions. Whilst not explicitly developed for SDM behaviour, the TDF has been used to explore barriers and facilitators from the perspectives of clinicians involving young people with internalising difficulties and their parents in SDM (Hayes, Edbrooke‐Childs, Town, Wolpert, & Midgley, ). Overall, 10 of the 14 domains were found to influence clinicians’ ability to engage in SDM.…”

“…Clinicians’ knowledge, skills, decision‐making processes and behavioural regulation affected their capability to engage in SDM with young people and parents, whilst social influences and their environment affected their opportunity. Lastly, their beliefs about the consequences of engaging in SDM, beliefs about their capabilities, emotions and professional role/identity affected their motivation (Hayes et al, ). The TDF has yet to be used with young people and parents to explore their capability, opportunity and motivation to engage in SDM.…”