Shared decision making in eating disorders: the patient and clinician perspectives

Shared Decision Making (SDM) is essential to establish a functional and efficient patient-clinician relationship. SDM appears challenging in mental health, and even more so in eating disorders (EDs). Treatment is complex, patients' engagement is difficult and robust evidence supporting the effectiveness of SDM in this field is still limited. This study aims to evaluate and compare SDM between patients with EDs and those with other major psychiatric conditions, and to identify potential predictors in SDM.

A total of 282 outpatients with major psychiatric disorders (i.e., bipolar disorder, anxiety disorder, depressive disorder, schizophrenia spectrum disorder, EDs) were consecutively recruited. For each consultation, both the patient and the treating clinician independently completed the Shared Decision Making-Questionnaire (SDM-Q-9) and its clinician version (SDM-Q-Doc).

Patient ratings of SDM (SDM-Q-9) do not significantly differ across diagnostic groups, whereas clinician ratings (SDM-Q-Doc) are significantly lower for the ED group only. No differences emerge among ED diagnosis, although patients with binge eating disorder tend to have higher SDM scores. Interestingly, differences between patient and clinician views on SDM emerge at specific stages of the decision-making process. Age, education and follow-up duration significantly contribute to explaining differences in SDM from both patients' and clinicians' points of view.

Patients with EDs perceive themselves as equally involved in treatment decision as those with other major mental disorders, yet clinicians report lower SDM in this group suggesting a perceptual gap. SDM in EDs is affected by socio-demographic and clinical variables. Further development of SDM techniques is crucial for improving the therapeutic alliance and addressing the cognitive and motivational features of EDs.