What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

Abstract

Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.

Perceptions of shared decision‐making in severe mental illness: An integrative review

“…Interestingly, MHPs rather than consumers were more likely to initiate SDM (Matthias, Fukui, & Salyers, ; Matthias et al, , Salyers et al ). Consumers in mental health settings may be reluctant to initiate SDM due to their previous experiences.…”

“…However, a randomized factorial survey showed no significant relationship between environmental factors and desire for SDM (Lukens et al, ). Ten of included studies, various stakeholders identified time constraint as the main barrier to SDM (Ali et al, ; Bradley & Green, ; Chong et al, ; Dahlqvist Jönsson et al, ; Fisher et al, , ; Giacco et al, ; Hamann et al, ; Matthias et al, ; Small et al, ; Younas et al, ). The availability of mental health services, especially continuity of care and inter‐professional collaboration, was also cited as an important facilitator to SDM (Chong et al, , ; Ehrlich & Dannapfel, ; Grim et al, ).…”

“…Interestingly, MHPs rather than consumers were more likely to (2012) found that when consumers initiate discussions, one third of these discussions lead to disagreement. Further, consumers who expressed their disagreement were more likely to be labelled with 'lack of insight' or 'low medication adherence' (Matthias et al, 2017). These unpleasing experiences may increase their reluctance to initiate SDM especially when they were suffering symptom exacerbations.…”

“…However, three studies identified it as a barrier to SDM (Eliacin et al, 2015a;Matthias et al, 2017;Park et al, 2014). Park et al (2014) found that those consumers who have a poorer therapeutic relationship with their MHPs had a greater preference for SDM (Park et al, 2014).…”

“…Park et al (2014) found that those consumers who have a poorer therapeutic relationship with their MHPs had a greater preference for SDM (Park et al, 2014). Similarly, consumers who had known their MHPs for less time were more likely to discuss treatment options (Matthias et al, 2017).…”