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Effects of Clinical Decision Topic on Patients' Involvement in and Satisfaction With Decisions and Their Subsequent
Marion Freidl1, Francesca Pesola1, Jana Konrad1
1Dr. Freidl is with the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (e-mail: marion.freidl@meduniwien.ac.at ). Dr. Pesola and Dr. Slade are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. Dr. Konrad and Dr. Puschner are with the Section on Process-Outcome Research, Department of Psychiatry II, Ulm University, Ulm, Germany. Dr. Kovacs and Dr. Nagy are with the Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Dr. De Rosa and Dr. Fiorillo are with the Department of Psychiatry, Second University of Naples, Naples, Italy. Dr. Krogsgaard Bording and Dr. Munk-Jørgensen are with the Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark. Dr. Kawohl and Dr. Rössler are with the Department of Psychiatry, University of Zurich, Zurich, Switzerland.
Objective:
Clinical decision making is an important aspect of mental health care. Predictors of how patients experience decision making and whether decisions are implemented are underresearched. This study investigated the relationship between decision topic and involvement in the decision, satisfaction with it, and its subsequent implementation from both staff and patient perspectives.
Methods:
As part of the Clinical Decision Making and Outcome in Routine Care for People With Severe Mental Illness study, patients (N=588) and their providers (N=213) were recruited from community-based mental health services in six European countries. Both completed bimonthly assessments for one year using the Clinical Decision Making in Routine Care Scale to assess the decision topic and implementation; both also completed the Clinical Decision Making Involvement and Satisfaction Scale.
Results:
Three categories of decision topics were determined: treatment (most frequently cited), social, and financial. The topic identified as most important remained stable over the follow-up. Patients were more likely to rate their involvement as active rather than passive for social decisions (odds ratio [OR]=5.7, p<.001) and financial decisions (OR=9.5, p<.001). They were more likely to report higher levels of satisfaction rather than lower levels for social decisions (OR=1.5, p=.01) and financial decisions (OR=1.7, p=.01). Social decisions were more likely to be partly implemented (OR=3.0, p<.001) or fully implemented (OR=1.7, p=.03) than not implemented.
Conclusions:
Patients reported poorer involvement, satisfaction, and implementation in regard to treatment-related decisions, compared with social and financial decisions. Clinicians may need to employ different interactional styles for different types of decisions to maximize satisfaction and decision implementation.
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