Conceptual understanding and applicability of shared decision‐making in psychiatric care: An integrative review

Abstract

Accessible Summary What is known on the subject? Shared decision‐making is a concept originating in the medical field, and it is ideally based on a trustful relationship between the patient and the health professionals involved. Shared decision‐making shows potential to strengthen patient autonomy and encourages patients to become involved in decisions regarding their treatment. What does the paper add to existing knowledge? A universal concept and understanding of shared decision‐making with relevance specifically to psychiatric clinical practice could not be identified in the analysed literature. Shared decision‐making refers to a process, and how and whether the patient wishes to participate in the decision‐making process should be clarified from the very beginning. On the basis of this synthesizing review, a process model for psychiatric practice was specified and illustrated to help lead health professionals, patients and other supporters through the decision‐making process. What are the implications for practice? The process of shared decision‐making should be made visible to all persons involved, and it should be stated at the beginning that a decision must be made. Decisions regarding treatment are usually not limited to a single consultation. A collaborative approach including multiple health professionals and other supporters, such as peer workers and family members, is required. Psychiatric nurses could support patients during the process of decision‐making and provide additional information, if requested. Abstract Introduction Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision‐making (SDM), as an informative and participative approach, is promoted in the scientific literature. Aim To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. Method An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health‐related databases were searched. Results Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient‐centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. Discussion SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient‐centred and recovery‐oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. Implications for Practice The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.

Integrating eHealth within a Transforming Mental Healthcare Setting: A Qualitative Study into Values, Challenges, and Prerequisites

“…This challenge put professionals in the dilemma to what extent eHealth should be used within person-centered care with shared-decision making when the client does not want to use eHealth. To understand this dilemma, it is helpful to delve into underlying assumptions within transforming practices shifting towards more recovery-oriented and person-centered care, such as clients are seen as experts on their own bodies, symptoms, and situations [51], and clients are empowered and participate in care decisions [3,[6][7][8][9]. Consequently, the result may be a stalemate, like in chess.…”

“…Moreover, access to and continuity of care and service quality have to be approved to meet the growing number of people facing psychological difficulties [1,5,6]. Health care services need to become more recoveryoriented, person-centered, and community-based in which shared-decision making is a matter of course [3,[6][7][8][9]. This central notion of empowerment is profound and complex and cannot be downsized to an expert giving power to a client [10].…”

Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations

“…Furthermore, the observer was familiar with the process of interprofessional psychiatric consultation and with the events on an acute psychiatric ward. Based on this assumption and a preliminary literature review, a guide was developed for the observation sequences and simultaneously used to create the protocol [ 36 ]. The observation guide was reviewed by a team of experts from the participating institution and adjustments were made based on their expertise.…”

Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study

“…Conceptual frameworks for SDM in the mental health care setting have also been suggested [ 23 – 25 ]. Morant et al [ 24 ] propose a conceptual framework that moves beyond the micro-social process.…”

“…They emphasize that a broader model is necessary in order to view SDM as a variety of related processes not only within, but also beyond a single psychiatric consultation. Gurtner et al [ 23 ] support this as they view SDM as a process that is usually not limited to a single consultation. This is important because mental illness often involves long-term treatment and thus requires that the patient and health professional interact in relationships over time [ 24 ].…”