Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study

Abstract

BackgroundDecisions on medical treatment setting are perceived as important but often difficult to make for patients with mental disorders. Shared decision-making as a strategy to decrease decisional conflict has been recommended, but is not yet widely implemented. This study aimed to investigate the information needs and the decision-making preferences of patients with mental disorders prior to the decision for a certain treatment setting. The results will serve as a prerequisite for the development of a high-quality patient decision aid (PtDA) regarding the treatment setting decision.MethodsWe conducted retrospective individual semi-structured interviews with n=24 patients with mental disorders in three psychotherapeutic inpatient care units. The interviews were audiotaped, transcribed, coded, and content-analyzed.ResultsThe majority of the patients wanted to be involved in the decision-making process. They reported high information needs regarding treatment options in order to feel empowered to participate adequately in the decision for a certain treatment setting. However, some patients did not want to participate or receive information, for example, because of their high burden of mental disorder. Whereas the majority were satisfied with the extent they were involved in the decision, few participants felt sufficiently informed about treatment options. Most patients reported that a decision aid regarding an appropriate treatment setting would have been helpful for them. Important information that should be included in a PtDA was general information about mental illness, effective treatment options, specific information about the different treatment settings, and access to treatment.DiscussionThe identified information and decision-making needs provide a valuable basis for the development of a PtDA aiming to support patients and caregivers regarding the decision for an adequate treatment setting. As preferences for participation vary among patients and also depend on the current mental state, a flexible approach is needed to meet patients’ individual wishes and needs.

Shared Decision-Making and Information Needs among People with Generalized Anxiety Disorder

“…First, the sample size was small and not randomly selected; gender distribution shows the rates observed in epidemiological studies (twofold in women), but most of the sample have secondary or university education, so it might be relevant to analyze the results in a sample with a lower education level. Nonetheless, results follow the line of those found in the literature [ 19 , 21 , 22 ]. Second, GAD diagnosis was not confirmed, and we cannot assure whether participants presented other anxiety or mental disorders.…”

“…The majority of patients preferred to share decisions with their clinicians, but they reported to be less involved than they would have liked to be. Similarly, the qualitative study by Kivelitz et al [ 22 ] found that patients with mental disorders wanted to be involved in the SDM process and to be informed with useful PtDAs about treatment options.…”

Shared decision making for adults with severe mental illness: A concept analysis

“…Several antecedents that might become barriers to implement SDM in the mental health field appeared, but there were also attributes that could overcome these barriers. First, despite the concerns about users' capacity to participate in the decision‐making process, this review found the feasibility of SDM for adults with SMI, giving practical examples including those in acute wards (An et al, 2017; Hamann et al, 2011, 2017; Ishii et al, 2017; Kivelitz et al, 2018; Stacey et al, 2016; Velligan et al, 2016; Zisman‐Ilani et al, 2019). Using user‐friendly visualization could be a bridge to allay such concerns and worries about the users' capacity.…”

Perceptions of shared decision‐making in severe mental illness: An integrative review

“…When reporting SDM as a multi-dimensional concept, there was greater variability in consumer preferences. The majority preferred to obtain information, discuss treatment options and express their views, and the minority want to make the final decision (Eliacin et al, 2015a;Fisher, Manicavasagar, Sharpe, Laidsaar-Powell, & Juraskova, 2017b;Kivelitz et al, 2018;Klingaman et al, 2015;Park et al, 2014;Velligan, Roberts, Sierra, Fredrick, & Roach, 2016). (Chong et al, 2013b;Shepherd et al, 2014;Younas et al, 2016).…”