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

98particular context for decision-making. The consumer may, for example, have otherphysical ailments or be in a living situation that constrains choice. The challengeentailed in making a satisfactory decision in the face of complex alternatives may beconsiderable, and using a DA may be helpful.Use of DAs is intended to result in more informed, and therefore improved, decisionmakingand/or an improved outcome. The two phenomena are different, and notnecessarily related. O’Connor et al. (2003) found that DAs increased knowledge ofoptions and outcomes, provided more realistic expectations of potential benefits andrisks, helped people feel more comfortable with their decisions, and improved theirinvolvement in decision-making. But few effects were found on the actual healthoutcomes individuals experienced. The very goal of behavioral health treatment andrecovery—changing thinking and behavior—would seem to suggest that improvingconsumers’ decision-making should be a focus, regardless of whether actual improvementin health outcomes is measurable. Furthermore, SDM can be seen as abasic human right, because every person should be able to determine what happensto his or her own body (Nelson, Lord, & Ochocka, 2001).Types of Decision AidsWhile the IPDAS Collaboration has identified the necessary elements of a DA, as previouslynoted, DAs nevertheless come in many different forms and vary along severaldimensions. This section of the paper categorizes DAs according to some of thosefactors. Different individuals have different learning styles and levels of educationand literacy; what is effective in helping one person may be less so for another. Asa result, DAs have been developed in a variety of formats. When DAs on any giventopic are available in several different formats, each individual can select the ones heor she finds most valuable. The following scheme may be useful in categorizing thevarious types of DAs.Passive, Active, or AssistedOne of the most important distinctions among DAs is whether the individual usesthem passively, actively, or with assistance. Passive DAs (i.e., those that entail noinvolvement on the part of the consumer other than reading, watching or listening)may include educational groups, booklets, brochures, audiotapes, or videos. DAsthat have an active component (i.e., those that enables the consumer to enter personalinformation, respond to questions and/or indicate decisions that then lead tovariable options) include computer-based support guides, interactive DVDs, decisionboards, and audio-guided workbooks. Yet other DAs may be used by the consumerwith guidance or assistance from a professional or paraprofessional.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions