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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
97• Provide balanced information, i.e., information about both the positive and thenegative features of the options;• Use plain language;• Use current scientific information;• Use consumer stories and/or testimonials;• Offer guidance or coaching;• Help the consumer to clarify his or her values; and• Disclose conflicts of interest.For the development of a comprehensive inventory of DAs, O’Connor et al. (2005)searched widely through the medical and social science literatures and databases,and contacted developers and evaluators known to them. Through this process theyidentified 221 DAs, of which 131 were currently available and had been developedwithin the preceding 5 years. The most frequent types of decisions covered by theaids were related to breast cancer, prostate cancer, menopause options, cardiovasculardisease, colon cancer screening and prenatal diagnostic testing. If any DAs addresseddecisions related to mental health, the article does not mention them.The same article describes a systematic review of randomized trials of DAs. The researchersidentified 636 citations that focused on decision-making, only 34 of whichultimately met the criteria for inclusion in their study. These studies evaluated 31different DAs which focused on 16 screening or treatment decisions in areas similarto those listed above; none addressed mental health. The lack of randomized trialsexamining mental health DAs does not indicate that no DAs exist for mental healthconditions. It does suggest, however, that mental health DAs are in an earlier stage ofdevelopment than are DAs for physical health.Situations in Which DAs are UsefulDAs are appropriate to situations in which several treatment options are availableto the health care consumer and the individual needs to weigh their advantages anddisadvantages in the context of his or her own life circumstances. The available optionsmay be likely to impose very different outcomes or complications; they mayentail tradeoffs between more immediate outcomes and longer term ones; their likelyoutcomes may be only slightly different; or one of the choices may possibly resultin a serious negative outcome (O’Connor, 2001). In addition (although the authorsdid not find this issue mentioned in the literature), the options may have differentfinancial implications. Moreover, each individual has unique characteristics and aShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions
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iiContentsIntroduction ............
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5outpatient commitment (Holmes-Rovn
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7Advantages• Practitioners can be
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9Section 2The Practice of SharedDec
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16Section 3SDM ResearchCurrent rese
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18Mental health care providers are
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21want mental health treatment or d
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23Some participants raised concerns
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31Section 6ConclusionsShared decisi
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33Fellowes, D., Wilkinson, S., & Mo
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35Power, A. Kathryn. (July 10, 2007
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37Appendix AResourcesThis list is p
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39Appendix BShared Decision-MakingM
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41Annelle Primm, M.D., M.P.H.Direct
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43Supplement 1Shared Decision-Makin
Page 51 and 52: 45IntroductionThe consumer-driven r
Page 53 and 54: 47Background: Definitions of SDM an
Page 55 and 56: 49• Freedom to live in the commun
Page 57 and 58: 51providers only (Wills & Homes-Rov
Page 59: 53SDM for Schizophrenia TreatmentBu
Page 63 and 64: 57I interact with my consumers; I f
Page 65 and 66: 59ReferencesAdams, J. R., & Drake,
Page 67 and 68: 61Elwyn, G., Edwards, A., Kinnersle
Page 69 and 70: 63Murray, E., Pollack, L., White, M
Page 71 and 72: 65Thistlethwaite, J., Evans, R., Ti
Page 73 and 74: 67AbstractShared decision-making is
Page 75 and 76: 69Confronting Critical Challenges:
Page 77 and 78: 71into treatment should still be in
Page 79 and 80: 73these approaches, people are more
Page 81 and 82: 75consumers to engage with their pr
Page 83 and 84: 77that were produced in the U.S., w
Page 85 and 86: 79a healing partnership and develop
Page 87 and 88: 81Shared Decision-Making in Mental
Page 89 and 90: 83However, peer support requires st
Page 91 and 92: 85ConclusionsImplementation of SDM
Page 93 and 94: 87Fellowes, D., Wilkinson, S., & Mo
Page 95 and 96: 89President’s Commission for the
Page 97 and 98: 91Supplement 3Aids to Assist Shared
Page 99 and 100: 93IntroductionSignificance of Share
Page 101: 95In recent years, a variety of tec
Page 105 and 106: 99Form of Access or AdministrationC
Page 107 and 108: 101ences). Some of these Web-based
Page 109 and 110: 103video about shared decision-maki
Page 111 and 112: 105clarify one’s own values and p
Page 113 and 114: 107potential results, than on quant
Page 115 and 116: 109Once again, however, it is worth
Page 117 and 118: 111who belong to minority groups or
Page 119 and 120: 113Hamann, J., Langer, B., Winkler,
Page 122: U.S. DEPARTMENT OF HEALTH AND HUMAN
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