Shared Decision-Making in Mental Health Care - SAMHSA Store ...

96begun to measure the impact of SDM and to determine whether it can achieve thesegoals. Some recent studies have found use of DAs to have a positive effect on consumersatisfaction (O’Connor et al., 2004; Thistlethwaite, Evans, Tie, & Heal, 2006).Definition of Decision Aid (DA)Decision aids (DAs), according to Adams and Drake, “are information interventionsthat help clients to understand the pros and cons of a medical decision and may alsoinclude exercises to help clients clarify their own values and preferences. They can beself-administered or used with a practitioner” (2006, p. 96). DAs are not the same ashealth education materials; they focus explicitly on alternatives in order to prepareconsumers to make important decisions (O’Connor et al., 2003). Nor are DAs simplybrochures or booklets developed by pharmaceutical companies or other entitieswhose ostensible purpose may be to educate, but whose actual intent is to validateand encourage the use of a specific therapeutic intervention.However, information is never value neutral. If a consumer received every bit of informationavailable on a particular topic, the resulting document would be severalinches thick and serve no purpose. There are always values behind decisions aboutwhat to include and what to omit from patient information, especially what typeand level of risk is meaningful for the consumer. If the writer of an informationaldocument really feels medication is valuable in most cases, this belief will be evidentin the material; if the writer feels that medication is overused and should be avoidedunless it is absolutely essential, then this notion will be part of the fabric of the presentation,even if he or she is trying to be neutral. Furthermore, the format in whichthe information is presented may also influence the reader (Wills & Holmes-Rovner,2003). Indeed, it is worth noting that research has demonstrated the effect of the useof positive or negative frames in describing the advantages and risks associated withmedical interventions (O’Connor, Pennie, & Dales, 1996).DAs have been developed and used far more widely for physical health care than formental health care. The International Patient Decision Aid Standards (IPDAS) Collaboration,a group of researchers, practitioners, and stakeholders, used a two-stageconsensus process to develop criteria by which DAs can be evaluated. According toIPDAS (2005), each DA should:• Include information about the available options;• Describe what happens in the natural course of the condition if no actionis taken;• Present the probabilities of various outcomes;Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions