Shared decision-making in ongoing outpatient psychiatric treatment

Area of Science:

• Psychiatry
• Clinical Psychology
• Health Services Research

Background:

• Previous research on patient involvement in psychiatric decision-making primarily focused on initial consultations.
• Ongoing outpatient visits represent a critical, yet less studied, context for shared decision-making in mental healthcare.

Purpose of the Study:

• To investigate the types of decisions made during ongoing psychiatric outpatient visits.
• To assess the level of patient involvement in these decisions.
• To identify factors influencing patient involvement in decision-making during routine psychiatric care.

Main Methods:

• Video recording of 72 outpatient psychiatric visits involving patients diagnosed with depression or schizophrenia.
• Analysis of decision-making processes and patient involvement levels across these recorded sessions.

Main Results:

• An average of one medication-related and one non-medication decision occurred per visit.
• Patient involvement in decision-making was influenced by the individual psychiatrist, with female psychiatrists showing higher involvement.
• Lower patient involvement was observed when patients presented with more negative symptoms.

Conclusions:

• Patient involvement in psychiatric decision-making during outpatient visits is influenced by psychiatrist characteristics and patient symptom profiles.
• The finding that visit length does not impact involvement is significant for clinical practice, suggesting opportunities for enhanced shared decision-making even in time-constrained settings.
• Future research should focus on identifying specific communication strategies employed by psychiatrists who effectively engage patients in decision-making.