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To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio-demographic, clinical, and psychological variables

  • Carlos De las Cuevas (a1) and Wenceslao Peñate (a2)

Abstract

Background

Shared decision making (SDM) is an essential component of patient-centered care, but there is little information about its use in the psychiatric care.

Objective

To measure to what extent psychiatric patients feel they were involved in the process and steps of decision making about treatment choice and to analyse the influence of socio-demographic, clinical, and psychological processes on this perception.

Methods

Cross-sectional survey involving 1100 consecutive psychiatric outpatients invited to complete the nine-item Shared Decision-Making Questionnaire (SDM-Q-9), health locus of control and control preferences, self-efficacy and drug attitude scales, as well as a questionnaire including socio-demographic and clinical variables.

Results

A high response rate of 77% was registered, resulting in a sample of 846 psychiatric outpatients. SDM-Q-9 total score indicate a moderately low degree of perceived participation, with differing perceived implementation of the individual the SDM process steps. Patient diagnosis evidenced significant differences in SDM perception. Patients’ perception of SDM was explained by four main variables: the older the patient, the lower self-reported SDM; having a diagnosis of schizophrenia increases the likelihood of lower SDM; a positive attitude towards psychiatric drugs favors greater SDM, as well as a higher level of self-efficacy.

Conclusion

The result of this study suggests that SDM is currently not widely practiced in psychiatric care. Further research is needed to examine if the low level of participation self-reported is justified by psychiatric patients’ decisional capacity.

Copyright

Corresponding author

Prof. Carlos De las Cuevas, Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, San Cristóbal de La Laguna, Spain. Tel: 0034 609 521 405; Fax: 0034 922 319 353; E-mail: cdelascuevas@gmail.com

References

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1.Taylor, K. Paternalism, participation and partnership – the evolution of patient centeredness in the consultation. Patient Educ Couns 2009;74:150155.
2.De Las Cuevas, C. Towards a clarification of terminology in medicine-taking behaviour: compliance, adherence and concordance are related although different terms with different uses. Curr Clin Pharmacol 2011;6:7477.
3.Pelto-Piri, V, Engström, K, Engström, I. Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care. BMC Med Ethics 2013;6:49.
4.Moulton, B, King, JS. Aligning ethics with medical decision-making: the quest for informed patient choice. J Law Med Ethics 2010;38:8597.
5.Loh, A, Leonhart, R, Wills, CE, Simon, D, Harter, M. The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns 2007;65:6978.
6.Coulter, A, Collins, A. Making Shared Decision-Making a Reality: No Decision About Me, Without Me. London: King’s Fund, 2011.
7.Härter, M. Shared decision making – from the point of view of patients, physicians and health politics is set in place. Z Arztl Fortbild Qualitatssich 2004;98:8992 (in German).
8.Elwyn, G, Charles, C. Shared decision making: from conceptual models to implementation in clinical practice. In: Edwards A, Elwyn G, editors. Shared decision-making in health care: achieving evidence-based patient choice. New York: Oxford University press, 2009:117121.
9.Fenton, WS. Shared decision making: a model for the physician-patient relationship in the 21st century? Acta Psychiatr Scand 2003;107:401402.
10.De Las Cuevas, C, Peñate, W, Perestelo-Pérez, L, Serrano-Aguilar, P. Shared decision making in psychiatric practice and the primary care setting is unique, as measured using a 9-item Shared Decision Making Questionnaire (SDM-Q-9). Neuropsychiatr Dis Treat 2013;9:10451052.
11.Holden, G. The relationship of self-efficacy appraisals to subsequent health related outcomes: a meta-analysis. Soc Work Health Care 1991;16:5393.
12.Schwarzer, R, Fuchs, R. Self-efficacy and health behaviors. In: Conner M, Norman P, editors. Predicting health behavior: research and practice with social cognition models. Buckingham, UK: Open University Press, 1996. 163196.
13.Shapiro, DH Jr, Schwartz, CE, Astin, JA. Controlling ourselves, controlling our world. Psychology’s role in understanding positive and negative consequences of seeking and gaining control. Am Psychol 1996;51:12131230.
14.Seibel, CA, Dowd, ET. Reactance and therapeutic noncompliance. Cognit Ther Res 1999;23:373379.
15.Janowski, K, Kurpas, D, Kusz, J, Mroczek, B, Jedynak, T. Health-related behavior, profile of health locus of control and acceptance of illness in patients suffering from chronic somatic diseases. PLoS One 2013; 10; 8:e63920.
16.Mcniel, DE, Gormley, B, Binder, RL. Leverage, the treatment relationship, and treatment participation. Psychiatr Serv 2013;64:431436.
17.Brehm, JW. Responses to loss of freedom: a theory of psychological reactance. Morristown, NJ: General Learning Press, 1972.
18.Brehm, SS, Brehm, JW. Psychological reactance: a theory of freedom and control. London: Academic Press Inc., 1981.
19.Wallston, KA. Hocus-pocus, the focus isn’t strictly on locus: Rotter’s social learning theory modified for health. Cogn Ther Res 1992;16:183199.
20.Bandura, A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84:191215.
21.Kriston, L, Scholl, I, Hölzel, L, Simon, D, Loh, A, Härter, M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 2010;80:9499.
22.De Las Cuevas, C, Perestelo-Perez, L, Rivero-Santana, A, Cebolla-Martí, A, Scholl, I, Härter, M. Validation of the Spanish version of the 9-item Shared Decision Making Questionnaire. Health Expect 2014. doi: 10.1111/hex.12183[Epub ahead of print].
23.Simon, D, Schorr, G, Wirtz, Met al.Development and first validation of the shared decision-making questionnaire (SDM-Q). Patient Educ Couns 2006;63:319327.
24.Hong, SM, Faedda, S. Refinement of the Hong psychological reactance scale. Educ Psychol Meas 1996;56:173182.
25.Wallston, KA, Stein, MJ, Smith, CA. Form C of the MHLC scales: a condition-specific measure of locus of control. J Pers Assess 1994;63:534553.
26.Schwarzer, R, Jerusalem, M. Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio. Causal and control beliefs. Windsor, England: NFER-NELSON, 1995. 3537.
27.Hogan, TP, Awad, AG, Eastwood, R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983;13:177183.
28.Simmons, M, Hetrick, S, Jorm, A. Shared decision-making: benefits, barriers and current opportunities for application. Australas Psychiatry 2010;18:394397.
29.Matthias, MS, Salyers, MP, Rollins, AL, Frankel, RM. Decision making in recovery-oriented mental health care. Psychiatr Rehabil J 2012;35:305314.
30.De Las Cuevas, C, Peñate, W, De Rivera, L. Psychiatric patients’ preferences and experiences in clinical decision-making: examining concordance and correlates of patients’ preferences. Patient Educ Couns 2014 (in press).
31.Hamann, J, Leucht, S, Kissling, W. Shared decision making in psychiatry. Acta Psychiatr Scand 2003;107:403409.
32.Hamann, J, Mendel, R, Cohen, Ret al.Psychiatrists’ use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics. Psychiatr Serv 2009;60:11071112.
33.Hamann, J, Langer, B, Winkler, Vet al.Shared decision making for in-patients with schizophrenia. Acta Psychiatr Scand 2006;114:265273.
34.De Las Cuevas, C, Rivero-Santana, A, Perestelo-Pérez, L, Serrano-Aguilar, P. Attitudes toward concordance in psychiatry: a comparative, cross-sectional study of psychiatric patients and mental health professionals. BMC Psychiatry 2012;12:53.
35.Friedberg, MW, Van Busum, K, Wexler, R, Bowen, M, Schneider, EC. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff 2013; 32, 2:268275.
36.Barry, MJ, Frosch, DL, Shannon, D, Bowen, M. Aligning incentives for patient engagement: enabling widespread implementation of shared decision making. Washington, DC: Informed Medical Decisions Foundation, 2013.
37.Legare, F, Witteman, H. Shared decision making: examining key elements and barriers to adoption into routine clinic practice. Health Aff (Millwood) 2013;32:276284.
38.Mccabe, R, Khanom, H, Bailey, P, Priebe, S. Shared decision-making in ongoing outpatient psychiatric treatment. Patient Educ Couns 2013;91:326328.
39.Légaré, F, Ratté, S, Stacey, Det al.Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2010;12:CD006732.
40.De Las Cuevas, C, Peñate, W. Preferences for participation in shared decision making of psychiatric outpatients with affective disorders. Open J Psychiatr 2014;4:1623.
41.Fadnes, L, Taube, A, Tylleskär, T. How to identify information bias due to self-reporting in epidemiological research. Internet J Epidemiol 2009;7(2).
42.Wang, P, Lane, M, Olfson, M, Pincus, H, Wells, K, Kessler, R. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:629640.
43.Smith, K, Matheson, F, Moineddin, Ret al.Gender differences in mental health service utilization among respondents reporting depression in a national health survey. Health 2013;5:15611571.
44.Hibbard, JH. Engaging health care consumers to improve the quality of care. Med Care 2003;41:I61I70.
45.Hibbard, JH, Greene, J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff 2013;32:207214.

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