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

Abstract

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.

Exploring motivations and resistances for implementing shared decision‐making in clinical practice: A systematic review based on a structure–process–outcome model

“…Consistent with other studies, decision‐making time was the main category influencing the use of SDM 28,43 . Both physicians and patients complained that due to time constraints, because of the brief consultation, sufficient explanation may not be provided, resulting in poor communication between them 27,43 . Then, the provision of sufficient resources in terms of staff and space can help distribute physicians' workloads, enabling longer interactions and provision of safe spaces for patients to express themselves without fear 44,55 .…”

“…Patients trusting physicians were the most frequently mentioned factor category under the patient‐related theme in the structure dimension; research showed that adequate trust could greatly improve the physician–patient relationship and make patients feel more comfortable in sharing their preferences, values and priorities within the trusting relationships, 27 , 60 , 61 , 62 while patients' preferences and priorities would contribute to less medical burden and more desired healthcare. Given the differences in patients' preferences, an individualized treatment option provided by physicians can motivate the practice of SDM.…”

“…Figures 3 and 4 show the distribution of factors. 'Trusting physicians' indicates a greater possibility for patients to participate in decision-making within trusting relationships, 27 while it appears to be negative when patients trust physicians unconditionally without a reciprocal relationship, 28 besides improving the motivation of participation facilitates for implementing SDM, and it is associated with the degree of family support and patients' social capital. [29][30][31] Additionally, patients with better physical health, decision-making skills and high health literacy are more easily involved in the adoption of SDM.…”

“…The screened factors covered 35 categories with cumulative frequencies of 159 times, in which the cumulative frequencies under the patient-related theme reached 44 times, physician-related theme reached 29 times and decision-making implementation reached 23 times. Four categories of factors, including decision-making time, health care environment, patients' decision-making readiness and physicians' communication skills, all had frequencies of 10 times or more.Furthermore, as the distribution among different types of studies for the same elements showed, the third and fourth types of studies were predominant.4 | DISCUSSIONWe identified 105 studies, comprising 53 qualitative studies and 52 quantitative studies, reporting motivation and resistance based on the SPO model to promote the process of SDM.Patients trusting physicians were the most frequently mentioned factor category under the patient-related theme in the structure dimension; research showed that adequate trust could greatly improve the physician-patient relationship and make patients feel more comfortable in sharing their preferences, values and priorities within the trusting relationships,27,[60][61][62] while patients' preferences and priorities would contribute to less medical burden and more desired healthcare. Given the differences in patients' preferences, an individualized treatment option provided by physicians can motivate the practice of SDM 1.…”

Exploration and Strategy Analysis of Mental Health Education for Students in Sports Majors in the Era of Artificial Intelligence

“…Next, the current situation of empirical research on the mental health of college students is introduced. Since the end of the 20th century, China has gradually strengthened the empirical investigation and research on the psychological status of college students while focusing on theoretical research ( Huang et al, 2021 ). According to the characteristics of college students, researchers use various scales, such as Cattell’s 16 personality factor (16PF), university personality inventory (UPI), and SCL-90 to study the psychological status of college students.…”