Involving patients in decisions during psychiatric visits

Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi Piazzale L.A. Scuro 10, 37134 Verona, Italy.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 12/2008; 193(5):416-21. DOI: 10.1192/bjp.bp.107.048728
Source: PubMed


Patient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry.
To assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement.
Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients.
Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level.
The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.

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    • "The ongoing sense that current models of service user and carer involvement continue to be less effective than first envisaged gives rise to an increasingly urgent need to elucidate the reasons why. Although contemporary health services are progressively utilising a wider range of user involvement strategies (Crawford et al., 2003; Tait and Lester, 2005), professional opinion is still alleged to dominate the majority of nursing practice (Goss et al., 2008). Pertinently, mental health nurses, psychiatrists and allied health and social care workers continue to provide the majority of care for mental health service users, yet in-depth explorations of their perceptions of user and carer involved care planning are sparse. "
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    ABSTRACT: Background Involving users/carers in mental health care-planning is central to international policy initiatives yet users frequently report feeling excluded from the care planning process. Rigorous explorations of mental health professionals’ experiences of care planning are lacking, limiting our understanding of this important translational gap. Objectives To explore professional perceptions of delivering collaborative mental health care-planning and involving service users and carers in their care. Design Qualitative interviews and focus groups with data combined and subjected to framework analysis. Setting UK secondary care mental health services Participants 51 multi-disciplinary professionals involved in care planning and recruited via study advertisements. Results Emergent themes identified care-planning as a meaningful platform for user/carer involvement but revealed philosophical tensions between user involvement and professional accountability. Professionals emphasised their individual, relational skills as a core facilitator of involvement, highlighting some important deficiencies in conventional staff training programmes. Conclusions Although internationally accepted on philosophical grounds, user-involved care-planning is poorly defined and lacks effective implementation support. Its full realisation demands greater recognition of both the historical and contemporary contexts in which statutory mental healthcare occurs.
    No preview · Article · Jul 2015 · International Journal of Nursing Studies
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    • "Over the past 20 years, shared decision making has been recommended as the optimal style to improve patient-orientation and quality of health care (The Lancet, 2011; Del Piccolo & Goss, 2012). Although it has been shown that people with mental illness want to be informed about and have a say in their care (Hamann et al. 2005; Hill & Laugharne, 2006), practitioners have largely failed to adopt principles of shared decision making in their daily routine (Goss et al. 2008; Karnieli-Miller & Eisikovits, 2009; Légaré et al. 2010; de las Cuevas et al. 2012; Storm & Edwards, 2013). Furthermore, the evidence base for the impact of shared decision making on health status is limited (Joosten et al. 2008), especially in mental health care (Duncan et al. 2010). "
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    ABSTRACT: Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR). Epidemiology and Psychiatric Sciences, Available on CJO 2015
    Full-text · Article · Feb 2015 · Epidemiology and Psychiatric Sciences
    • ") was used to assess the extent to which clinicians involve patients in decisions across a range of situations in clinical practice . The OPTION scale has been used to date in both observational and intervention studies ( Elwyn et al . , 2004 ; Goossensen et al . , 2007 ; Goss et al . , 2008 ; Pellerin et al . , 2011 ) . This 12 items instrument applies a five - point scale with a raw total score ranging from 0 ( score 0 in all items ) to 48 ( score 4 in all items ) . Raw scores are normally transformed into a 0 – 100 score . Thus , a score of two equates to the observation of minimal skills level and a score of 50 would in"
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    ABSTRACT: Little is known on how the conceptual description of Shared Decision Making (SDM) accomplishes clinical practice in the context of lifetime disabilities as in particular Autism Spectrum Disorders (ASD), when intervention is long-lasting and requires constant family involvement. This study aimed mainly to investigate to what extent the staff's competence in SDM contributes to positive child and parent improvement when involving parents in Early Intensive Behavior Interventions (EIBI). It was also geared to verify whether SDM staff competence contributes to a child's treatment responsiveness. A total of 25 young children with ASD (23 male, 3 female, age range 34-92 months, mean age 51.4±13.6) were included in the study. Of these, nine children were allocated to a Parent Involvement condition accompanied by SDM Staff Training (PI-SDM), and eight children to a Parent Inclusion in Treatment Delivery Only condition without SDM Staff Training (PI-DO). Nine months treatment outcomes of severity, developmental and adaptive measures were compared to Treatment As Usual (n=8). PI-SDM was associated with improvement of autistic symptoms (p≤.05), adaptive functioning (p≤.01) and developmental outcome (p≤.01), as well as parent (p≤.05) and staff competence (p≤.001). The magnitude of outcome was inferior in the PI-PO and TAU group. A Reliable Change was identified in more than 40% of children included in PI-SDM, while PI-PO (>20%) and TAU (>12%) let to little Reliable Change and partially skill deterioration. Staff's SDM skill competence predicts reduced parental stress (β=-.500, p≤.05) and contributes significantly to a positive treatment responder trajectory (p≤.01), besides lower severity (p≤.05), higher adaptive (p≤.01) and communication skills (p≤.05). The study indicates that parent inclusion should be conceptualized as a collaborative partnership model rather than as adherence in treatment provision, based on a target SDM staff training that may constitute an external contributor to treatment responsiveness and positive child as well as parent outcome. Copyright © 2014 Elsevier Ltd. All rights reserved.
    No preview · Article · Dec 2014 · Research in Developmental Disabilities
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