Provider Perspectives on Implementing Shared Decision Making for PTSD Treatment in VA Primary Care

Area of Science:

• Mental Health Implementation Science
• Healthcare Provider Perspectives
• Evidence-Based Practice Adoption

Background:

• Shared decision making (SDM) is a key strategy to increase the use of evidence-based mental health practices.
• Patient-facing decision support tools can facilitate SDM at the start of mental health treatment.
• Understanding provider perspectives is crucial for successful implementation of SDM.

Purpose of the Study:

• To explore mental health provider views on implementing SDM using a PTSD decision aid.
• To identify facilitators and barriers to SDM in primary care mental health settings.
• To understand provider preferences for patient engagement in SDM.

Main Methods:

• Qualitative study using semi-structured interviews.
• 22 mental health providers (psychiatrists, nurses, psychologists, social workers) were interviewed.
• Thematic analysis was used to analyze interview data from VA primary care clinics.

Main Results:

• Providers were enthusiastic about decision aids for enhancing patient experience and treatment confidence.
• Concerns included decision aid accessibility, time constraints for in-session SDM, and patient motivation.
• Providers preferred to use SDM with highly motivated patients with fewer barriers to care.

Conclusions:

• Provider enthusiasm for decision aids is high, but practical implementation challenges exist.
• Beliefs about patient motivation may limit the reach of SDM to less engaged patient groups.
• Targeting SDM to highly motivated patients may hinder widespread adoption and miss opportunities to engage difficult-to-reach individuals.