Patient considerations in trauma-focused treatment decision-making: a qualitative study

Post-traumatic stress disorder (PTSD) is a common psychiatric condition, with a global prevalence of 3.9% and a lifetime prevalence of 7.4% in the Netherlands. Although numerous evidence-based treatments are available, their use varies considerably. Understanding patient perspectives and experiences in the decision-making process when choosing a specific treatment is crucial for improving the quality of care.

This study aimed to explore the decision-making process from the perspective of patients with PTSD, focusing on their considerations and experiences when choosing a specific psychotherapeutic treatment.

In this qualitative study, twelve semi-structured interviews were conducted with patients with PTSD (aged 21-55 years) receiving care at a mental health organisation in the east of the Netherlands. Data were analysed using reflexive thematic analysis, informed by grounded theory-inspired analytic techniques. Analysis was iterative and inductive, focusing on the identification and interpretation of patterns of meaning across patients' accounts.

Five themes were identified, connected through an overarching interpretive concept of patient-attunement: (1) the role of treatment characteristics (2), the role of therapeutic factors (3), the role of treatment duration and intensity (4), the role of significant others, and (5) the role of information about trauma-focused treatment. Patients emphasised the importance of personalised information and support from clinicians and significant others. Ongoing responsiveness within the therapeutic relationship, including trust and collaboration, was central to experiencing the decision-making process as supportive and meaningful.

For patients with post-traumatic stress disorder, multiple factors play a role in choosing a psychotherapeutic trauma-focused treatment. This study shows that continued attunement to patients' diverse needs is central to the decision-making process. Such attunement may take various forms, including attention to the therapeutic relationship, discussion of treatment characteristics and frequency, and responsiveness to patients' preferences regarding information provision. Involving patients' support systems may further support decision-making. Together, these findings suggest that clinicians should remain attentive to patients' needs at multiple points during the pre-treatment phase. Approaches such as shared decision-making may help facilitate this attunement.

Not applicable.