Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study

Abstract

Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.

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

“…The attribute of user‐friendly visualization was mainly derived from the information sharing phase of the communication process. When explaining the diagnosis and related options, the health professionals are devoid of medical jargon (Grim et al, 2016), rather they are familiar with plain language, simple statistics, and narrative stories in consideration of the users' different literacy and recovery levels (Martin et al, 2015; Velligan et al, 2016; Zaini et al, 2018). Tailor‐made verbal information is essential (Chong et al, 2013b), and combination with visible information is also important (Grim et al, 2016).…”

“…First, the active participation of the users in the decision-making process has been increasingly advocated (Klausen, Blix, Karlsson, Haugsgjerd, & Lorem, 2017;Perestelo-Perez et al, 2017). Government policies in many countries are currently more interested in promoting user-centered healthcare (Chong et al, 2013b;Klingaman et al, 2015;Sather, Iversen, Svindseth, Crawford, & Vasset, 2019;Younas, Bradley, Holmes, Sud, & Maidment, 2016). Second, in recent years, every part of mental health care is being committed to recovery, increasing emphasis of the users' roles as active participants (Mahone et al, 2011).…”

“…SDM tends to be perceived of as a time-consuming method (Schön et al, 2018). Particularly, outpatients' services have many users to visit in a very short time (Zaini et al, 2018). This may make it difficult to prioritize time for implementing new methods (Schön et al, 2018).…”

“…Fourth, SDM could promote the service users' wellness (Goscha & Rapp, 2015;Ramon, Morant, Stead, & Perry, 2017). Not many but some studies reported that SDM could improve the users' condition and some symptoms (Zaini et al, 2018;Metz et al, 2019).…”

<p>Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel</p>

“…73 A focus group study involving 19 psychiatrists and 11 patients with major depressive disorder was conducted at an urban teaching hospital in Malaysia to develop a strategic tool for SDM in the use of antidepressants. 74 The tool included a booklet of scripts for doctors which was adapted from the "Elwyn's three-talk model of shared decision-making" and a patient decision aid prior to "team talk". 75 The model depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss tradeoffs, before deliberation based on informed preferences.…”