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

Abstract

Aim: Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. Methods: Rodgers' evolutionary concept analysis was used. MEDLINE, Psy-chINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. Results: Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship. Conclusions: Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.

Redesigning phase 3 and 4 trials to adopt shared decision making

“…Moreover, neither the free distribution of psychotropic substances in a non-therapeutic context (safe supply), nor the available opioid agonist treatments (OAT), which are largely based on buprenorphine as first-line medication, have helped slow down the accumulating death toll. 3 A similar critical situation is also unfolding in two Baltic states, Lithuania and Latvia. 4 This crisis is having a direct effect on life expectancy, and is challenging the field of psychiatry, which is failing in the treatment of substance use and concurrent disorders.…”

“…Key elements of shared decision making are tailored and user-friendly information, choice awareness, attention for values and preferences, and a decision process in which users and clinicians co-interact. 2,3 Shared decision making helps to change the traditional power asymmetry in mental health care by strengthening the decisional position of service users, and paves the way for personalised and deliberate decisions, a strong coalition between users and mental health-care professionals, and better treatment adherence. 2,3 Therefore, it is not only a practical arrangement, but also a conceptual change in how people with mental health problems, their caregivers, and care teams should collaborate in a triad.…”

“…2,3 Shared decision making helps to change the traditional power asymmetry in mental health care by strengthening the decisional position of service users, and paves the way for personalised and deliberate decisions, a strong coalition between users and mental health-care professionals, and better treatment adherence. 2,3 Therefore, it is not only a practical arrangement, but also a conceptual change in how people with mental health problems, their caregivers, and care teams should collaborate in a triad. This arrangement is radically different from the more authoritative style clinicians employed in the past.…”

Development and acceptability of a decision aid for chronic insomnia considering discontinuation of benzodiazepine hypnotics

“…We formed a steering committee that comprised experts on insomnia and DA methodology. This committee included ten psychiatrists who routinely treated people with chronic insomnia, a psychologist who routinely conducted CBT-I, and a psychiatric nurse who was familiar with SDM literature in psychiatry 19 and had experience in developing DAs for mood disorders. 20,21 2.4 | Literature review…”

Exploring sustainable care pathways.

“…This context suggests the urgent need for easy access to a range of treatments and providers (Cole and Houston, 1999). Essential elements in this care process are open communication and well-organized, delegated coordinating roles for interprofessional care teams (Vanhaecht et al, 2006, Aoki, 2020. With care pathways, high-performance teams can be built (Rutman et al, 2017).…”