Discussing Treatment Options and Risks With Medical Patients Who Have Psychiatric Problems

Abstract

Discussing medical treatment options and risks becomes a more complicated task when patients have psychiatric problems. Such patients may perceive risk and judge options differently from usual, they raise special issues about informed consent and competency, and they may present special needs and stresses in the physician-patient relationship. This article addresses how to approach such treatment discussions within the framework of 3 content areas of the medical interview (medical decision making, informed consent, and the physician-patient relationship) and 2 formal techniques of the interview (exploration and assertion). Clinical research regarding how psychiatric problems may affect each of these areas of concern is reviewed. Ultimately, the goal of understanding such variations--and of possessing methods to address them in discussing treatment options and risks--is to help the patient be as free as possible from the burden of biases or distortions in making his or her decisions and to promote the best fit between the patient's wishes and the physician's medical judgment.

PreliminaryTurkish study of psychiatric in‐patients’ competence to make treatment decisions

“…This dimension focused on patients’ acceptance of their disease and related presented reasons, and evaluated the expectations of patients regarding whether they would or would not benefit from their treatments. Delusions and lack of insight in psychotic disorder prevents appreciation of the disease and treatment, and impairs decision‐making competence (Leo, ; Ness, ; Rudnick, ; Van Staden and Krüger, ). There are some reports that the competency of patients with psychotic disorders is lower than that of patients with other psychiatric disorders (Appelbaum, ; Cairns et al ., ; Fraguas et al ., ).…”

Monitoring of the decision making competence and adherence of patients with schizophrenia and schizoaffective disorder on lai treatment

“…Putting the above into the context of the medical encounter, a helpful model described by Ness 403 delineates three content areas of the medical interview-medical decisionmaking, informed consent, and the physician-patient relationship. Informed consent is clearly just one component of medical discussions.…”