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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
99Form of Access or AdministrationConsumers may access a DA in a variety of ways. O’Connor et al. (2003) foundthat of the 131 DAs they inventoried that were “up-to-date, completed and available,”94 were Web-based, 14 paper-based, 12 were videos with print resources, 8were audio-guided print resources, 2 were CD-ROMs, and 1 was Web-based with aworkbook. Most of these formats, including the Web-based resources, the videos, theaudio-guided print resources, and the CD-ROMs may be intended for the consumerto use on a personal computer, presumably in the privacy of his or her home. (Theauthors did not delve into this level of detail on use of the DAs.) If so, access mightbe problematic for mental health consumers, many of whom have low incomes andlack home computers, although consumer-run organizations often make computersavailable to those who need them. DAs can also be administered in group settingswith facilitators or individually with case managers, nurses, or other staff.Focus on a Specific Diagnosis and/or Treatment, or on Decision-making in GeneralAs previously noted, DAs often focus on one decision related to a specific treatmentfor a particular diagnosis. These aids present, in simple language, the known benefitsof the treatment as well as its known risks or disadvantages. They may includedimensions other than the strictly medical, such as social or emotional implications(O’Connor et al., 1999).There are also decision frameworks derived from psychological and economic modelsthat focus on helping people optimize their decisions on any issue. One exampleis the Ottawa Personal Decision Guide, subtitled “For People Facing Tough Healthor Social Decisions” (Ottawa Health Research Institute, 2005). This guide suggestsa series of four steps:• Clarify the decision;• Identify your decision-making needs: support, knowledge, values, and certainty;• Explore your needs (including a chart that helps in balancing benefits andrisks); and• Plan the next steps based on your needs.These generic frameworks do not meet the criteria for formal DAs because they donot contain actual information on pros and cons, or probabilities of various outcomes.They may, however, prove useful in situations for which no DAs exist, but adifficult decision must be made.Shared 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
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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 and 102: 95In recent years, a variety of tec
Page 103: 97• Provide balanced information,
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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