Shared Decision-Making in Mental Health Care - SAMHSA Store ...

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16Section 3SDM ResearchCurrent research on SDM has focused primarily on Western Europe and the UnitedStates, and on the use of SDM in general health care. Additional research is neededto increase understanding of the use or perceptions of SDM in other cultures and inmental health care.SDM in General Health CareAs discussed previously, research has demonstrated a strong interest in SDM amongboth consumers and providers. Additional research is needed to explore the reasonsSDM is not more widely used by health care providers. In addition, the reluctanceof some consumers to utilize SDM could be further explored, to determine if suchreluctance can—or should be—ameliorated.Other outcomes of interest, such as a greater sense of involvement in decision-making,are difficult to quantify. Research on health outcomes is ongoing; to date, feweffects on health outcomes have been demonstrated (O’Connor et al., 2002).SDM in Mental Health CareCelia Wills, R.N., Ph.D. provided an overview of the research on SDM in mentalhealth care at the SDM meeting. Both the practice of and research on SDM in mentalhealth are still in the early stages, and newer research is primarily concentrated in thecountries of Western Europe and the United States. More studies in populations ofgreater cultural diversity are needed to strengthen the evidence base and understandingof SDM in mental health care.A number of studies have been conducted, primarily with consumers with depressionor schizophrenia, over the last 5 years. General findings regarding patients withdepression include the necessity for more information, decision support, and involvement.Patients with depression generally expressed a strong interest in informationand involvement. Interventional studies demonstrated improvements in knowledge,decision stage, and involvement, and a reduction in depression and stress. Lowerpreferences for SDM were found among consumers with severe depression or consumerswho reported a lack of agreement with their medical diagnosis. These consumergroups also demonstrated a lower capability for digesting information orbecoming involved in decision-making (Simon et al., 2007).A strong interest in information and involvement was also documented amongconsumers with schizophrenia. Positive outcomes were demonstrated, includingimproved knowledge, higher involvement, and improved social function andShared Decision-Making in Mental Health Care:Practice, Research, and Future Directions
17satisfaction. Physicians in these studies expressed concern about the decision-makingcapability of consumers with schizophrenia.Specific studies highlighted by Dr. Wills include:• A survey of 96 consumers with schizophrenia found most were interested inSDM especially in regard to medication (Bunn, O’Connor, Tansey, Jones, &Stinson, 1997);• A randomized control trial of SDM among consumers with schizophrenia inBerlin found that those involved in SDM were more knowledgeable than thosein usual care (Hamann, Cohen, Leucht, Busch, & Kissling, 2005; Hamann etal., 2006);• SDM was associated with improved social interaction and satisfaction in a2-year randomized control trial of two Swedish community-based treatmentprograms for people with schizophrenia (Malm, Ivarsson, Allebeck, & Falloon,2003); and• An intervention study at Michigan State University of persons with diabeteswho also have depression found improved knowledge, improvement in decisionstage, greater satisfaction with decision-making, improved involvement,and decreased depression and stress with SDM (Wills, 2006).Dr. Wills reported that the Michigan State University study included an analysisof the feasibility of the intervention—a depression decision support booklet. Thebooklet was evaluated as easy to read, and more than 80 percent of participants reportedthat the time required to complete the materials, the amount of information,and the balance of information provided were appropriate. The decision-makingexercises were found to be helpful in activating or clarifying consumers’ thinkingabout decisions, and case illustrations of others’ decisions were reported to be veryhelpful. Consumers with more severe depression or lower education levels reportedthat the materials required effort, but were still helpful. Project partners perceivedthe intervention to be a value-added aspect of diabetes self-management educationand described it as a feasible intervention.Liability ConcernsThe doctor-patient relationship is defined to include legal and financial responsibilitiesand rights. The effect of employing SDM within a mental health care settingmust be explored in light of these existing rights and responsibilities. Participants atthe SDM meeting suggested that other models might inform new understandings ofresponsibilities and liability in the context of SDM. For example, a tax accountant isa professional with particular expertise hired to provide particular services. The honestinput of the consumer, however, is understood to be critical to the accountant’sability to provide those services.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions
Page 4: iiContentsIntroduction ............
Page 11 and 12: 5outpatient commitment (Holmes-Rovn
Page 13 and 14: 7Advantages• Practitioners can be
Page 15: 9Section 2The Practice of SharedDec
Page 24: 18Mental health care providers are
Page 27 and 28: 21want mental health treatment or d
Page 29: 23Some participants raised concerns
Page 37 and 38: 31Section 6ConclusionsShared decisi
Page 39 and 40: 33Fellowes, D., Wilkinson, S., & Mo
Page 41 and 42: 35Power, A. Kathryn. (July 10, 2007
Page 43 and 44: 37Appendix AResourcesThis list is p
Page 45 and 46: 39Appendix BShared Decision-MakingM
Page 47 and 48: 41Annelle Primm, M.D., M.P.H.Direct
Page 49 and 50: 43Supplement 1Shared Decision-Makin
Page 51 and 52: 45IntroductionThe consumer-driven r
Page 53 and 54: 47Background: Definitions of SDM an
Page 55 and 56: 49• Freedom to live in the commun
Page 57 and 58: 51providers only (Wills & Homes-Rov
Page 59: 53SDM for Schizophrenia TreatmentBu
Page 63 and 64: 57I interact with my consumers; I f
Page 65 and 66: 59ReferencesAdams, J. R., & Drake,
Page 67 and 68: 61Elwyn, G., Edwards, A., Kinnersle
Page 69 and 70: 63Murray, E., Pollack, L., White, M
Page 71 and 72: 65Thistlethwaite, J., Evans, R., Ti
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67AbstractShared decision-making is
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69Confronting Critical Challenges:
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71into treatment should still be in
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73these approaches, people are more
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75consumers to engage with their pr
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77that were produced in the U.S., w
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79a healing partnership and develop
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81Shared Decision-Making in Mental
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83However, peer support requires st
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85ConclusionsImplementation of SDM
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87Fellowes, D., Wilkinson, S., & Mo
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89President’s Commission for the
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91Supplement 3Aids to Assist Shared
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93IntroductionSignificance of Share
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95In recent years, a variety of tec
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97• Provide balanced information,
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99Form of Access or AdministrationC
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101ences). Some of these Web-based
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103video about shared decision-maki
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105clarify one’s own values and p
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107potential results, than on quant
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109Once again, however, it is worth
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111who belong to minority groups or
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113Hamann, J., Langer, B., Winkler,
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U.S. DEPARTMENT OF HEALTH AND HUMAN
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