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

104the naïve user might still not recognize the distinction between WebMD’s own offeringsand those of its sponsors.Evidence Supporting Specific DAsO’Connor et al. (2003), who examined more than 100 DAs for people facing healthtreatment or screening decisions, concluded that:Those that have been evaluated in randomized controlled trials havehad positive effects on the decision making process with improvedknowledge and realistic expectations, enhanced participation in decisionmaking, lowered decisional conflict, reduced proportion remainingundecided, and improved agreement between values and choice. . .. Patients, practitioners, insurers, and health policy makers may needmore empirical evidence about the effectiveness of decision aids beforetheir wide-scale implementation can occur (p. 16).They point out that few of the DAs available on the Internet have been evaluated,and that little is known about practitioners’ attitudes toward DAs or about the impactDAs have on communication between consumers and their clinicians. All ofthese are issues that are especially critical to the development and use of DAs inmental health care.Most of the DAs to which the public currently has access have not been developedin research settings, and have not been subjected to thorough study in terms of theirimpact on either decision-making or clinical outcomes. As mentioned earlier, theboundary between the kinds of DAs that are developed for research purposes, andformally tested, and those that are available to the public on the Web, usually forfree, is not a firm or clear one.DAs in Mental Health CareAs this paper has indicated, there are relatively few aids available to guide decisionmakingin mental health care. The majority of those that exist relate to depressionand seem geared to individuals with mild or moderate depressions. This section presentsinformation the authors have been able to gather on existing mental health DAsand on the apparent barriers to creating more of them.Availability of DAs for Mental HealthWhile most of the resources listed on the following pages do not explicitly call themselves“decision aids,” they do fulfill that function: in line with the definition used inthis paper, they help individuals understand the positive and negative implicationsof a medical decision. Many include information if not exercises that can help oneShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions