Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences

Seale, Clive; Chaplin, Robert; Lelliott, Paul; Quirk, Alan

doi:10.1016/j.socscimed.2005.11.002

Cited by 143 publications

(154 citation statements)

References 35 publications

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“…Congruent with previous research, 13,19 physicians appear to be open to SDM, but not under all circumstances. Thus, if a patient resists a doctorÕs recommendation that the doctor believes to be reasonable and in the patientÕs best interest, doctors become afflicted by doubts whether a paternalistic decision might not be better in the long-term interest of the patient.…”

Section: Mean (Sd)contrasting

confidence: 45%

How should patients behave to facilitate shared decision making – the doctors’ view

Hamann

Mendel

Bühner

et al. 2011

Health Expectations

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Objective To study how physicians feel about patientsÕ efforts to be engaged in shared decision making (SDM).Study setting and design Survey of physicians from distinctly different medical disciplines (238 psychiatrists and 169 vascular surgeons). Participants were requested to judge which patient behaviours they find helpful and which behaviours detrimental for SDM.Results Psychiatrists and surgeons had rather positive attitudes about active patient behaviours. However, there were quite a few patient behaviours (e.g. searching the Internet, being assertive towards the doctor) which provoked ambivalent or negative attitudes.Discussion and conclusions Physicians are generally quite open towards active patient behaviour in the consultation. They, however, do consider it as less helpful and become more annoyed if patients insist on their preferences and doubt their doctorsÕ recommendations. Physicians must realize that SDM implies giving up decisional power and try to be more flexible in their interactions with patients.

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Section: Mean (Sd)contrasting

confidence: 45%

How should patients behave to facilitate shared decision making – the doctors’ view

Hamann

Mendel

Bühner

et al. 2011

Health Expectations

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“…However endorsement of SDM is often seen as situation or topic dependent and overall professionals are seen to have ambivalent attitudes towards SDM (Seale, Chaplin, Lelliott, & Quirk, 2006). While some research purports that professionals consider SDM to be partially non beneficial under certain circumstances (Hamann et al, 2009), others suggest that it should be condition or decision topic dependent (Chong et al, 2013a;Hamann et al, 2009;Simmons, Hetrick, & Jorm, n.d.) and some again argue that it is important to not uncritically apply concepts of SDM coming from other areas of health care to MH (Kaminskiy, E., Ramon, S., Morant, 2013).…”

Section: Professionals' General Endorsement For Sdmmentioning

confidence: 99%

“…For instance, they see them as "experts by experience", as patients lacking insight, or as patients with questionable validity of views and questionable experiences et cetera. The different views can lead to ambivalent views of service user involvement in decision making (Kaminskiy, Ramon, and Morant, 2013;Seale et al, 2006).…”

Section: Factors Related To the Service Usermentioning

confidence: 99%

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Attitudes towards shared decision making in mental health: a qualitative synthesis

Kaminskiy

Senner

Hamann

2017

MHRJ

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PurposeShared Decision Making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users' experiential knowledge, values and preferences.. This article reviews the existing literature pertaining to key stakeholders' attitudes towards SDM in mental health. It examines whether perceived barriers and facilitators differ by group (e.g. service user, psychiatrist, nurse, social worker) and includes views of what facilitates and hinders the process for service users and practitioners. MethodologyThis review adopts the principles of a qualitative research synthesis. A key word search of research published between 1990 and 2016 was undertaken. Qualitative, quantitative and mixed methods studies were included. Findings43 papers were included and several themes identified for service user and practitioner perspectives. Both practitioners and service users see SDM as an ethical imperative, and both groups highlight the need to be flexible in implementing shared decision making, suggesting it is context dependent. A range of challenges and barriers are presented by both practitioners and service users reflecting complex contextual and cultural features within which interactions in mental health take place. There were qualitative differences in what service users and practitioners describe as preventing or enabling SDM. The differences highlighted point towards different challenges and priorities in SDM for service users and practitioners. Originality / ValueThe presentation of nuanced views and attitudes that practitioners and service users hold represent an important and under reported area and offer insight into the reasons for the gap between idealised policy and actual practice of SDM in mental health settings.

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“…Not all clients desire high levels of autonomy (Levinson, Kao, Kuby & Thisted, 2005; Say, Murtagh & Thompson, 2006), and psychiatrists have been found to both value and criticize elements of SDM including the exchange of unbiased information (Seale, Chaplin, Lelliott & Quirk, 2006). To elucidate these discrepancies, we elicited perspectives from clients and mental health clinicians about their experiences making and facilitating medication decisions and about strategies that might support client-clinician communication, improve client informed choice, and promote safe and appropriate antipsychotic medication treatment.…”

Section: Making (Cmsdm) To Propose a Communication-centered Epistemicmentioning

confidence: 99%

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Mikesell

Bromley

Young

et al. 2015

Health Communication

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Shared decision making (SDM) interventions aim to improve client autonomy, information sharing and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued clientcentered priorities such as autonomy and empowerment when making decisions.However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: 1) the role of communication and information exchange and 2) the value and stability of clinician and client epistemic expertise.Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of SharedDecision Making (CEM-SDM).3The quality of mental health care has been argued to be largely dependent on the quality of client-clinician communication (Priebe & McCabe, 2008), which is critical for accomplishing clinical tasks and improving health outcomes (Alegría et al., 2008;Wissow et al., 2008). The model of shared decision making (SDM) reconceptualizes client-clinician communication (Patel, Bakken & Ruland, 2008) by redefining the terms by which participants come together to make treatment decisions (Drake, Deegan & Rapp, 2010). In a SDM frame, neither clinicians (paternalistic model) nor clients (informed choice model) are singularly responsible for making decisions (Makoul & Clayman, 2006). Instead, decision making is characterized by the exchange of unbiased information (Drake et al., 2010), collaboration (Charles, Gafni & Whelan, 1999) and mutual respect for differing expertise (Deegan & Drake, 2006). Given the centrality of communication in mental health care, we believe the assumptions underlying SDM warrant critical examination.For instance, despite widespread support for SDM, its principles are not uniformly perceived or advocated. Not all clients desire high levels of autonomy (Levinson, Kao, Kuby & Thisted, 2005; Say, Murtagh & Thompson, 2006), and psychiatrists have been found to both value and criticize elements of SDM including the exchange of unbiased information (Seale, Chaplin, Lelliott & Quirk, 2006). To elucidate these discrepancies, we elicited perspectives from clients and mental health clinicians about their experiences making and facilitating medication decisions and about strategies that might suppo...

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Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences

Cited by 143 publications

References 35 publications

How should patients behave to facilitate shared decision making – the doctors’ view

How should patients behave to facilitate shared decision making – the doctors’ view

Attitudes towards shared decision making in mental health: a qualitative synthesis

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

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