Shared decision-making (SDM) is a process by which clinicians and patients collaborate on treatment choices based on both patient preferences and clinical evidence. Although patients with psychotic disorders want to be more involved in decisions about their care, they have limited opportunities to do so due to various barriers. Knowledge of healthcare professionals' experiences with SDM is important for successful implementation. The aim of this study was to describe and explore health professionals' SDM experiences with patients with psychotic disorders. Three focus group interviews were conducted with 18 health professionals who work in one of three Norwegian mental health centres where patients with psychotic disorders are treated. We used a descriptive and exploratory approach using qualitative content analysis. Health professionals understand the concept of SDM primarily as giving patients information and presenting them with choices between different antipsychotic drugs. Among the barriers to SDM, they highlighted that patients with psychosis have a limited understanding of their health situation and that it takes time to build trust and alliances. Health professionals understand patients with psychotic disorders mainly as a group with limited capacity to make their own decisions. They also described the concept of SDM without thinking about presenting different treatment options. Psychological or social interventions were often presented as an adjunct to antipsychotic medication rather than as an alternative to it. Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They believe that patients with psychotic disorders have limited opportunities to participate in decisions about their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.
Mental health professionals' experiences with shared decision-making for patients with psychotic disorders: a qualitative study
18 December 2022