Shared Decision Making and Serious Mental Illness
Section snippets
Methods
This study was a cross-sectional, correlational study of persons with SMI living in the community. The sample consisted of 85 clients being served at four sites of a community mental health center in Central Virginia and surrounding counties. The data were collected from February to October, 2005. Approval was obtained from the institutional review board at the University of Virginia and each participant signed a consent form prior to being interviewed.
Table 1, Table 2 present descriptors of
Findings
Background variables with operational definitions, sample size, means, standard deviations, and percentages are presented in Table 3. Following descriptive analysis of the study variables, the relationships between the independent and dependent variables were established using multiple and logistic regression analysis, controlling for the background variables correlating most highly with the outcome variables.
Background Variables
Background variables included demographic, socioeconomic, and health care utilization variables (see Table 3). The sample ranged in age from 20 to 62 years, 58% were men, 93% were single, and 56% had some college education or were college graduates. Seventy-six percent of participants lived independently yet only 31% were employed. Seventy-six percent of participants had an income of less than $10,000 and 17% lived in rural areas. Years of treatment was operationalized by number of years since
Limitations and future research
Limitations of this study include small sample size, limited variability in preferences and participation, and a narrow definition of adherence. In addition, the design of selecting clients from those attending an established clinic prevented inclusion of clients seeking crisis intervention or those receiving services elsewhere and may have excluded sicker clients.
The long-term goal of this study is to design and test an SDM intervention aimed at increasing medication adherence. Because a
Conclusion
This study was another step in understanding the associations among key factors in medication decision making by persons with SMI. Potential barriers to SDM in the psychiatric population were identified. Because much of health care today has already successfully embraced illness self-management and SDM (Barlow et al., 2002, Walker et al., 2003), demonstrating the relationships among these variables in persons with SMI contributes to understanding the responses and attitudes of clients and to
Acknowledgment
This research was funded in part by the National Institute for Nursing Research NRSA Grant 1-F31-NR-8453-1A2; a Phyllis Veronick Research Award, Beta Kappa Chapter, Sigma Theta Tau International; and an Ann O'Brien Leone Scholarship at University of Virginia, Charlottesville, VA.
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2022, International Journal of Medical InformaticsCitation Excerpt :Shared decision-making was assessed through three items that were originally developed by Bekker and Stiggelbout [33] and Rencz and Tamási [7]. Patient outcomes was measured using four items developed by Mahone [34], Lerman and Brody [35], and Stewart and McWhinney [25], after some modifications. The draft questionnaire was reviewed by an expert panel that consisted of one kidney specialist familiar with shared decision-making and a professor who specialized in health information management.
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2016, European PsychiatryCitation Excerpt :Some of them could be applied to our findings. First, patients’ health worldview, including health belief models, treatment preferences, involvement of family, greater trust in their physician and attitude may vary and influence a patient's preference for participation (influence by cultural attitudes and tradition) [37–40]. Second, perceived lack of knowledge, lack of self-efficacy or a learned response influenced by cultural attitudes may contribute to this as well [38–40].
Shared Decision Making in Mental Health Treatment: Qualitative Findings From Stakeholder Focus Groups
2011, Archives of Psychiatric NursingCitation Excerpt :The decision-making process refers to how medical scientific information is combined with personal values to form preferences, which in turn shape decisions, behavior, and outcomes (Wills & Holmes-Rovner, 2006). Although preliminary studies on SDM show mixed results, some positive outcomes that have been demonstrated include improvements in general functioning, illness symptoms, insight, quality of life, health-related quality of life, satisfaction with medication, satisfaction with care, community tenure, patient knowledge, quality of physician/ patient relationship, and attitudes to drug treatment; greater patient willingness to participate and patient perceived involvement; and fewer bed days and side effects (Deegan, 2007; Hamann et al., 2006; Joosten et al., 2008; Mahone, 2008; Schauer, Everett, del Vecchio, & Anderson, 2007). Optimal mental health treatment is an individualized process where providers collaborate with service users to tailor the best possible services and supports for that individual, based on the person's needs, strengths, preferences, and recovery goals (Adams & Drake, 2006).
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