Measuring shared decision making processes in psychiatry: skills versus patient satisfaction

To measure to what extent clinicians in a psychiatry department involve patients in decision making about treatment choice and to compare these data with patients' satisfaction rates about clinician communication behaviours.

Communication was analyzed by scoring 61 audio taped consultations with a validated instrument (OPTION). Patients scored satisfaction on the same OPTION behaviours. Eight clinicians were involved, as were 61 patients.

The clinicians scored on average 43 points at overall 'shared decision making', on a scale of 0-100. Clinicians performed well in asking if patients had any questions. They scored low on meta-items about the decision making process: checking the preferred approach of the patient to receive information, or checking the preferred level of involvement in decision making. Satisfaction scores of a group of 29 patients showed no concern about these low scores.

The clinicians in this study did not ask meta questions about participation in decision making. An explanation given was that they intuitively 'feel' if a patient wants to be involved or not. Patients did not express great concern about this. More experiments with clinicians openly checking desired participation levels of patients are needed, in order to learn more about possibilities in meta communication, and possible biases of clinicians.

Our starting point was that clinicians need to become experts in all roles of their profession, as communicator as well as medical expert. Providing mirror information by assessing decision making behaviours will help to improve performance. Clinicians should be able to perform these SDM behaviours, even if patients are not asking for participation. Claims that clinicians do empathically feel if patients are able to involve in decision making, should be checked by scientific experiments.