Lived experiences of shared decision-making in young adults prescribed antipsychotics: a qualitative interview study

Serious mental illnesses, such as schizophrenia, schizoaffective or bipolar disorder, often starts in late teens or twenties. Adherence to antipsychotic treatment for serious mental illness is often poor. Involving service users in decisions about their treatment leads to improved clinical outcomes and adherence. Shared decision-making is bilateral information sharing between clinician and service user where decision-making is shared between both parties. This study aimed to evaluate the lived experiences of young adults on how healthcare professionals involve them in decisions about antipsychotic medication.

Fifteen semi-structured interviews were conducted online using Zoom. Participants were selected using purposive sampling via patient recruitment platform, support groups relevant to psychosis and social media. Those included in the study were diagnosed with schizophrenia, schizoaffective or bipolar disorder and treated with antipsychotics between the ages of 18-30. Data was coded inductively and thematic analysis was used to analyse the data.

Four themes were identified. These were living with antipsychotics, influence of family and friends, gaining autonomy and consequences of young adulthood. Findings highlighted the range of side effects from antipsychotic medication and their impact on young adults, and how the choices made by health care professionals influenced the quality of shared decision-making. Health care professionals' decisions directly influence the quality of life for service users. Young adults with psychosis acknowledge the effectiveness of antipsychotics but see the side effects as significant obstacles in their lives.

The study found that health care professionals provided limited acknowledgement and support for antipsychotic side effects, which significantly impacted the young adults' lives. Young adults want to be fully informed of their medication and potential side effects but support from friends and family was a potential barrier. Changes in practice are needed including an adjustment in clinical language used by health care professionals, giving information to service users' post-psychosis and ensuring health care professionals are trained in shared decision-making.