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102patient decision aid (i.e., are designed to help people make specific choices by providinginformation about the relevant options and outcomes and by clarifying personalvalues); have a development process that includes expert review; have an updatepolicy; use scientific evidence; and disclose their funding sources and/or conflicts ofinterest (Ottawa Health Research Institute, 2008). The inventory assesses the extentto which each aid meets IPDAS criteria.The Cochrane Collaboration. The Cochrane Collaboration, founded in 1993, isan independent, international, not-for-profit organization that makes informationavailable about the effects of health care interventions. It produces and disseminatessystematic reviews of interventions and promotes study of them (Cochrane Collaboration,2007). The Cochrane Inventory, which lists all identified DAs (including thosethat are still under development and some that are no longer available) currentlyincludes 343 DAs. The Web address is http://www.cochrane.org.Foundation for Informed Medical Decision Making. This foundation is a not-forprofitorganization that creates SDM programs in videotape and other forms tobring medical evidence together with an “appreciation of patients’ attitudes andpreferences regarding treatment alternatives.” It works in partnership with HealthDialog (see below) to distribute its materials, and does not make those materialsavailable directly to the public. The foundation also sponsors research into decisionmakingin health care. At the time of this writing, the 2006 recipient of their dissertationfellowship was studying “shared decision making for patients with severe andpersistent mental illness.” The foundation’s Web address is http://www.fimdm.org.Health Dialog, Inc. Health Dialog is a for-profit company that offers a program tohelp health plans, employers, government entities, and providers support individualsin their health care. Health Dialog’s program provides individuals served by itsclient organizations with round-the-clock access to health coaches (specially trainedhealth care professionals) who offer help by supporting decisions as well as in avariety of other ways. They also provide educational tools and resources online,in print, on audiotapes, and in videos. Health Dialog produces its videos in collaborationwith the Foundation for Informed Medical Decision Making (see above),and does not make them available to the general public. The Web site is located athttp://www.healthdialog.com.Sources of DAs available to the publicCenter for Shared Decision Making, Dartmouth-Hitchcock Medical Center. TheFoundation for Informed Medical Decision Making and Health Dialog, Inc. helps tosupport this center, which is the first in the United States focused on helping patientsmake all kinds of medical decisions, and offers its services free of charge. Individualscan call to make an appointment, send questions via e-mail, visit the office (inLebanon, NH), and/or borrow materials. The center’s decision aid library offers aShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions
103video about shared decision-making, The Informed Health Care Consumer, whichintroduces evidence-based medicine and shared decision-making. The library makesavailable materials on a variety of diagnoses; different topics naturally have differentnumbers of items associated with them. Among the center’s online resources,the topic of mental health lists only a 35-minute video titled Coping with Symptomsof Depression (for more information on this video, see under Health Dialog).Other materials and forms of assistance are available at the center’s Web site,http://www.fimdm.org.Healthwise®. Healthwise is a not-for-profit organization founded in 1975 whosemission is to help consumers make better health care decisions. One of the principalsources of DAs, Healthwise has developed 107 “Knowledgebase Decision Points.”They report that nearly 30 million of their health care guides have been distributed,and that people use their DAs nearly 90 million times a year. Numerous organizations,including health plans, providers, and government agencies, work withHealthwise and distribute their materials. Healthwise makes its DAs available tothe public, but through others’ Web sites rather than their own. OHRI, for example,offers access to many Healthwise DAs through links; OHRI’s site also assessesthe extent to which DAs meet IPDAS criteria. The organization’s Web address ishttp://www.healthwise.org.NexCura®. NexCura, part of Thomson Scientific & Healthcare, offers a systemthat allows each individual to complete an online profile. This information is thenmatched with the organization’s database of relevant scientific information to providean individualized DA. NexCura works with not-for-profit organizations (suchas the American Cancer Society and the American Heart Association), medical centers,health plans, major corporations, and commercial Web sites, each of which embedsthe NexCura tools within its own Web site. NexCura markets its methodologyto pharmaceutical companies, suggesting that it can serve purposes other than thoseof just the consumer. The Web address is http://www.nexcura.com.WebMD. Although WebMD does not offer DAs per se, it does provide extensive freeinformation and constitutes a vast and significant Web presence in the health arena.Its Web site (http://www.webmd.com) includes information organized by symptomand by disease; drug information; information specifically geared to women, men,and children; and guidance about virtually every aspect of health, wellness, and fitness.It has a huge “Depression Health Center” that includes information on specificdrugs, psychotherapy, and on “living and managing,” as well as offering blogs,advice, and a long list of links to other resources. It also suggests “questions to askyour doctor about depression.” WebMD has its own staff of experts and writers whowrite and review what appears on the site; it also has links with MedicineNet.com.As all-encompassing as it is, WebMD’s vast site could be somewhat confusing to aconsumer who lacks familiarity with the cyberworld. For example, it incorporates agreat deal of “sponsored information.” This material is clearly labeled as such, butShared 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
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47Background: Definitions of SDM an
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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 and 104: 97• Provide balanced information,
Page 105 and 106: 99Form of Access or AdministrationC
Page 107: 101ences). Some of these Web-based
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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