Editorial: Shared Decision Making in Mental Health: International Perspectives on Implementation

BACKGROUND Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and therefore, develop evidence-based recommendations for practice. OBJECTIVE To determine the feasibility of undertaking a cluster randomized control trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. METHODS Overall, 270 young people were screened for participation and 53% (N = 142) were recruited and completed baseline measures across eight specialist child mental health services (n = 62, mean (SD) age = 14.66 (1.99) years, 52% female) and two mainstream secondary schools (n = 80; mean (SD) age = 16.88 (0.68) years, 46% female). Young people received Power Up in addition to management as usual or received management as usual only. Post-trial interviews were conducted with 11 young people from the intervention arms (specialist services n = 6; schools n = 5). RESULTS Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported: 1) their motivation for use of Power Up, 2) the impact of use, and 3) barriers to use. Out of the 142 recruited participants, 45% (64/142) completed follow up measures, and the approaches to increase retention agreed by the steering group are discussed. CONCLUSIONS The findings of the present research indicate that the app is acceptable and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized control trial. CLINICALTRIAL ISRCTN: ISRCTN77194423, ClinicalTrials.gov NCT02552797

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Measurement issues of shared decision making in mental health: challenges and opportunities

Mental Health Review Journal ◽

10.1108/mhrj-01-2017-0004 ◽

2017 ◽

Vol 22 (3) ◽

pp. 214-232 ◽

Cited By ~ 4

Author(s):

Lilisbeth Perestelo-Perez ◽

Amado Rivero-Santana ◽

Yolanda Alvarez-Perez ◽

Yaara Zisman-Ilani ◽

Emma Kaminskiy ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Decision Making ◽

Mental Health Care ◽

Shared Decision Making ◽

Self Report ◽

Psychometric Validation ◽

Shared Decision ◽

Deliberative Process ◽

Content Type

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

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Patients’ Understanding of Shared Decision Making in a Mental Health Setting

Qualitative Health Research ◽

10.1177/1049732314551060 ◽

2014 ◽

Vol 25 (5) ◽

pp. 668-678 ◽

Cited By ~ 33

Author(s):

Johanne Eliacin ◽

Michelle P. Salyers ◽

Marina Kukla ◽

Marianne S. Matthias

Keyword(s):

Mental Health ◽

Decision Making ◽

Shared Decision Making ◽

Shared Decision ◽

Mental Health Setting

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

BMC Health Services Research ◽

10.1186/s12913-020-05949-1 ◽

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.

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