Clinical Decision-Making During Psychiatric Ward Rounds.

Area of Science:

• Psychiatry
• Clinical Psychology
• Healthcare Management

Background:

• Ward rounds are critical for decision-making in psychiatric inpatient care.
• Existing research on shared decision-making (SDM) primarily focuses on outpatients and individual consultations.
• The dynamics of SDM within the unique setting of psychiatric inpatient ward rounds require specific investigation.

Purpose of the Study:

• To investigate shared decision-making (SDM) patterns during psychiatric inpatient ward rounds.
• To compare patient and physician perceptions of SDM during these rounds.
• To identify factors influencing patient engagement and satisfaction during ward rounds.

Main Methods:

• Cross-sectional study involving 62 psychiatric inpatients across seven wards.
• Data collection included patient and physician questionnaires pre- and post-ward round.
• Interaction recordings were used to assess observer-rated SDM.

Main Results:

• Two patient groups emerged: those with no expectations and those with a clear agenda for ward rounds.
• Patients with a clear agenda demonstrated higher active engagement, anticipated more decisions, and discussed more topics.
• Observer-rated SDM was generally low, with significant discrepancies between patient and physician perceptions.

Conclusions:

• Perceptions of ward rounds and SDM differ significantly between psychiatric inpatients and their treating physicians.
• A paternalistic doctor-patient relationship is prevalent, yet patients report high satisfaction and perceived involvement.
• Optimizing ward rounds for SDM requires motivating patients to prepare agendas and enhancing participation and information dissemination.