Patient and provider contributions to shared decision making in a modular primary care behavioral health anxiety...

The objective of this work was to describe shared decision-making (SDM) domains within the context of a modular anxiety intervention provided in primary care behavioral health within a large organized care setting by (a) identifying patient and provider behaviors that exemplify each domain and (b) quantifying the frequency of these behaviors. Participants were 15 veterans (87% male) with anxiety symptoms randomized to the intervention. The intervention was designed as a brief, modular intervention specifically for primary care behavioral health and was delivered by using primary care behavioral health-trained study interventionists (N = 5). Using established SDM theory, deductive qualitative analysis identified and described SDM domains in audio recordings of initial intervention sessions. SDM-congruent behaviors occurred in all sessions with frequencies ranging from 13.3% to 100%. Common provider behaviors included the following: invites questions, validates, and asks the patient to share (recognition of areas of expertise); sets expectations, describes roles/treatments, provides psychoeducation, and links psychoeducation with the patient's specific symptoms (mutual sharing of information); asks about desired changes and preferred modules (discussion regarding treatment preferences); and agrees with the patient's choice (joint making of decision). Common patient behaviors included the following: readily responds and complies with instructions (recognition of areas of expertise), describes symptoms and gives examples (mutual sharing of information), lists goals (discussion regarding treatment preferences), and chooses an option (joint making of decision). A new domain, active listening (with behaviors such as uses listening sounds, uses reflection, and clarifies reports), was also identified. Findings enhance understanding of what SDM "looks like" in clinical practice by providing clear behavioral exemplars of SDM and may guide how to increase engagement in SDM during provision of patient-centered care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).