Call for shared decision making in China: Challenges and opportunities

Int J Mental Health Nurs

Lam

Zhong

et al. 2020

The implementation of shared decision-making regarding people diagnosed with schizophrenia is limited, although it is reported to have a positive impact on improving treatment adherence, therapeutic relationships and saving medical costs. The successful implementation of it is mainly dependent on the active engagement of mental health professionals. This study aims to identify mental health professionals' perceptions of shared decision-making regarding people diagnosed with schizophrenia in collectivist cultures such as Chinese culture. A qualitative descriptive approach was used, involving ten individual interviews with psychiatrists and four focus groups with twenty-three mental health nurses from the psychiatry department of a tertiary hospital in mainland China. An inductive thematic approach was used to analyze the data. Two main themes with five subthemes generated: willingness to engage in shared decision-making and perceiving shared decision-making as unachievable. The last theme included five subthemes: (i) deference to authority, (ii) tension between family decision-making and patient autonomy, (iii) uncertainty of trusting therapeutic relationships, (iv) implicit persuasion and (v) insufficient consultation time. Patients often lack opportunity and support to engage in decision-making. Mental health nurses in other countries need to be aware that Chinese patients and patients with a similar background are not knowledgeable about or value shared decision-making to the extent that other countries might. They need to evaluate and support them, including encouraging them to engage in decision-making as well as providing appropriate information. Mental health nurses need to collaborate with patients and their families to achieve patient-centred care when family involvement is expected.

Section: Introductionmentioning

confidence: 99%

Chinese mental health professionals’ perceptions of shared decision‐making regarding people diagnosed with schizophrenia: A qualitative study

Int J Mental Health Nurs

Lam

Zhong

et al. 2020

Section: Review Of Sdm Instruments In Chinamentioning

confidence: 99%

“…Health professionals in China are recognizing the importance of SDM in the provision of health service, and researchers are demonstrating an interest in SDM in mental health services (Huang et al, 2015;Yao, Finnikin, & Cheng, 2017). However, relevant knowledge remains relatively rare, and its implementation in China lags behind Western countries (Huang et al, 2015;Yao et al, 2017). Instruments measuring SDM available in Chinese are limited, one focuses on the decision-making process (The 9-item Shared Decision-making Questionnaire, SDM-Q-9) and its psychometric tests in the Chinese population has been completed (Luo, & Xiao, 2019a, 2019b, others were designed for a particular study and lacked evidence of validity and reliability (Shu, Wang, & Yao, 2010;Yang, 2014).…”

Section: Review Of Sdm Instruments In Chinamentioning

confidence: 99%

Translation and psychometric testing of a decision‐making scale

Psychiatric Ment Health Nurs

Plummer

Lam

et al. 2020

Accessible summary What is known about shared decision‐making? There is increasing investigation of shared decision‐making in mental health services. Exploration of shared decision‐making and relevant instrument is scant in China. What this paper adds to existing knowledge? In this study, the Clinical Decision‐making Involvement and Satisfaction (CDIS) was translated into Chinese and validated with patients and mental health professionals. The Chinese version of the CDIS is a reliable and valid instrument for measuring perception of involvement and satisfaction with treatment decision for schizophrenia What are the implications for practice? Mental health nurses could use the CDIS patient‐rated and health professional‐rated versions to compare their perceptions of the decision‐making process. Abstract IntroductionThere is growing interest in shared decision‐making in Chinese mental health services. However, few specific instruments are available to measure decision‐making satisfaction and involvement. AimTo translate and validate Clinical Decision‐making Involvement and Satisfaction (CDIS) in a Chinese population. MethodsThe translation process was completed based on the Brislin translation method. Convenience sampling of 505 participants including 212 people diagnosed with schizophrenia and 293 mental health professionals for psychometric testing (e.g., content and construct validity, and test‐retest reliability). ResultsThe CDIS Chinese version has good internal consistency and temporal stability. Factor analysis determined two factors including satisfaction and involvement subscales, explaining 60.08% of the total variance. The Cronbach's α was 0.70, and the intraclass correlation coefficient ranged from 0.83 to 0.89. The composite reliability value was 0.85, and the average variance extracted was 0.50. Critical Ratio values ranged from 5.28 to 17.95, and item‐total correlation values ranged from 0.48 to 0.75. DiscussionThe CDIS Chinese version is a feasible and reliable instrument.

“…Relevant studies in China are limited and suggest that there is an increasing recognition that SDM could play an essential role in promoting health (Huang et al, 2015; Yao et al, 2017). These studies also indicate that there are multiple barriers (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…These studies also indicate that there are multiple barriers (e.g. limited recognition of people‐centred care and mental health services) to overcome before this approach becomes a reality (Huang et al, 2015; Yao et al, 2017). Therefore, this study explored SDM to further evidence the development of SDM in China.…”

Section: Introductionmentioning

confidence: 99%

I am the person who knows myself best: Perception on shared decision‐making among hospitalized people diagnosed with schizophrenia in China

Int J Mental Health Nurs

Plummer

Wang

et al. 2020

Shared decision-making is related to better health outcomes in serious mental illness. It is not well addressed in non-Western cultures, for example Chinese culture. Chinese could be influenced by both paternalism and familism when making treatment decisions. However, this is unexplored. The study purpose is to explore shared decision-making from perspectives of inpatients diagnosed with schizophrenia in China. This study adopted qualitative descriptive approach. Through semi-structured interviews, twelve participants from the psychiatry department of a tertiary hospital shared their perceptions of shared decision-making. An inductive thematic approach was used to analyse the transcripts. Primary results included three main themes with nine subthemes: (1) Having a positive attitude: i) wanting my voice to be heard, ii) needing my family to be involved, and iii) preferring the psychiatrist to decide; (2) Feeling excluded: i) having limited financial capacity, ii) lacking interactive communication, iii) too few psychiatrists, and iv) being unsatisfied with informed consent process; and (3) Self-motivation in decision-making by: i) easing the burden on the family and ii) actively collecting health information. In this context, patients have fewer treatment options and a limited role in SDM. Yet, they have preference for SDM, actively seeking health information from mental health professionals particularly nurses.