scholarly journals Mental health professionals’ perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nafiso Ahmed ◽  
Sally Barlow ◽  
Lisa Reynolds ◽  
Nicholas Drey ◽  
Fareha Begum ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Risk Management ◽  
Shared Decision Making ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Perceived Barriers ◽  
Shared Decision ◽  
Barriers And Enablers

Abstract Background Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO: CRD42016050457) aimed to explore the perceived barriers and enablers to implementing shared decision-making in risk assessment and risk management from mental health professionals’ perspectives. Methods PRISMA guidelines were followed in the conduct and reporting of this review. Medline, CINAHL, EMBASE, PsycINFO, AMED and Internurse were systematically searched from inception to December 2019. Data were mapped directly into the Theoretical Domains Framework (TDF), a psychological framework that includes 14 domains relevant to behaviour change. Thematic synthesis was used to identify potential barriers and enablers within each domain. Data were then matched to the three components of the COM-B model: Capability, Opportunity, and Motivation. Results Twenty studies met the eligibility criteria. The findings of this review indicate that shared decision-making is not a concept commonly used in mental health services when exploring processes of risk assessment and risk management. The key barriers identified were ‘power and best interest’ (social influences) and ‘my professional role and responsibility’ (social/professional role and identity). Key enablers were ‘therapeutic relationship’ (social influences) and ‘value collaboration’ (reinforcement). The salient barriers, enablers and linked TDF domains matched COM-B components ‘opportunity’ and ‘motivation’. Conclusion The review highlights the need for further empirical research to better understand current practice and mental health professionals’ experiences and attitudes towards shared decision-making in risk assessment and risk management.

scholarly journals Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Espen W. Haugom ◽  
Bjørn Stensrud ◽  
Gro Beston ◽  
Torleif Ruud ◽  
Anne S. Landheim
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Psychotic Disorders ◽  
Successful Implementation ◽  
Practical Training ◽  
Shared Decision ◽  
Antipsychotic Medications

Abstract Background Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient’s preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals’ experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals’ SDM experiences with patients with psychotic disorders. Methods Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. Results Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. Conclusion Health professionals’ understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.

scholarly journals Negotiating styles adopted by consultant psychiatrists when prescribing antipsychotics

2007 ◽  
Vol 13 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Robert Chaplin ◽  
Paul Lelliott ◽  
Alan Quirk ◽  
Clive Seale
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Therapeutic Alliance ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Qualitative Interview ◽  
Shared Decision ◽  
Adherence To Medication ◽  
Qualitative Interview Study ◽  
Improve Clinical Outcome

A good therapeutic alliance between mental health professionals and patients with psychosis can enhance adherence to medication regimens and improve clinical outcome. This article explores how the therapeutic alliance might be developed with respect to decisions to prescribe antipsychotic medication. It does this by presenting the implications for practice that arise from a recent qualitative interview study with consultant psychiatrists. We consider strategies for strengthening the therapeutic alliance, occasions when it might be appropriate to suspend shared decision-making temporarily, techniques used to enable discussion of symptoms and side-effects, and how issues of adherence are uncovered and addressed. Psychiatrists already possess considerable skills in these areas. The dissemination of these to colleagues forms an important opportunity for CPD.

scholarly journals Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

2015 ◽  
Vol 21 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Louise Hjort Nielsen ◽  
Sarah van Mastrigt ◽  
Randy K. Otto ◽  
Katharina Seewald ◽  
Corine de Ruiter ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Risk Management ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Assessment Practices ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Monitoring ◽  
Professional Disciplines

Abstract With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

scholarly journals Collaborative risk assessment in secure and forensic mental health settings in the UK

2020 ◽  
Vol 33 (5) ◽  
pp. e100291
Author(s):  
Sarah Markham
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Health Policy ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Forensic Mental Health ◽  
Mental Health Settings ◽  
The Uk ◽  
Risk Assessment And Management

Collaborative risk assessment and management have been recommended in health policy for over a decade. We consider the nature and need for collaborative risk assessment and management between patients and clinicians in secure and forensic mental health settings in the context of shared decision making and personalised care in the UK. We examine the extent to which policy and recent initiatives have influenced the embedding of such practice in services through consideration of the evidence provided by research and the Commissioning for Quality and Innovation framework, and conclude that there is a need for further improvement.

scholarly journals Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

2021 ◽  
Vol 18 (4) ◽  
pp. 2128
Author(s):  
Marta Maes-Carballo ◽  
Manuel Martín-Díaz ◽  
Luciano Mignini ◽  
Khalid Saeed Khan ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Societies ◽  
New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

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