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Decision making in recovery-oriented mental health care.

Abstract：

OBJECTIVE:Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in making decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. METHODS:Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. RESULTS:Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers' preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, Internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers' recovery.

journal_name

Psychiatr Rehabil J

journal_title

Psychiatric rehabilitation journal

authors

Matthias MS,Salyers MP,Rollins AL,Frankel RM

doi

10.2975/35.4.2012.305.314

subject

Has Abstract

pub_date

2012-04-01 00:00:00

pages

305-14

issue

eissn

1095-158X

issn

1559-3126

pii

480227857R448210

journal_volume

pub_type

杂志文章

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Decision making in recovery-oriented mental health care.