16Section 3SDM ResearchCurrent research on SDM has focused primarily on Western Europe and the UnitedStates, and on the use of SDM <strong>in</strong> general health care. Additional research is neededto <strong>in</strong>crease understand<strong>in</strong>g of the use or perceptions of SDM <strong>in</strong> other cultures and <strong>in</strong>mental health care.SDM <strong>in</strong> General <strong>Health</strong> <strong>Care</strong>As discussed previously, research has demonstrated a strong <strong>in</strong>terest <strong>in</strong> SDM amongboth consumers and providers. Additional research is needed to explore the reasonsSDM is not more widely used by health care providers. In addition, the reluctanceof some consumers to utilize SDM could be further explored, to determ<strong>in</strong>e if suchreluctance can—or should be—ameliorated.Other outcomes of <strong>in</strong>terest, such as a greater sense of <strong>in</strong>volvement <strong>in</strong> decision-mak<strong>in</strong>g,are difficult to quantify. Research on health outcomes is ongo<strong>in</strong>g; to date, feweffects on health outcomes have been demonstrated (O’Connor et al., 2002).SDM <strong>in</strong> <strong>Mental</strong> <strong>Health</strong> <strong>Care</strong>Celia Wills, R.N., Ph.D. provided an overview of the research on SDM <strong>in</strong> mentalhealth care at the SDM meet<strong>in</strong>g. Both the practice of and research on SDM <strong>in</strong> mentalhealth are still <strong>in</strong> the early stages, and newer research is primarily concentrated <strong>in</strong> thecountries of Western Europe and the United States. More studies <strong>in</strong> populations ofgreater cultural diversity are needed to strengthen the evidence base and understand<strong>in</strong>gof SDM <strong>in</strong> mental health care.A number of studies have been conducted, primarily with consumers with depressionor schizophrenia, over the last 5 years. General f<strong>in</strong>d<strong>in</strong>gs regard<strong>in</strong>g patients withdepression <strong>in</strong>clude the necessity for more <strong>in</strong>formation, decision support, and <strong>in</strong>volvement.Patients with depression generally expressed a strong <strong>in</strong>terest <strong>in</strong> <strong>in</strong>formationand <strong>in</strong>volvement. Interventional studies demonstrated improvements <strong>in</strong> knowledge,decision stage, and <strong>in</strong>volvement, and a reduction <strong>in</strong> depression and stress. Lowerpreferences for SDM were found among consumers with severe depression or consumerswho reported a lack of agreement with their medical diagnosis. These consumergroups also demonstrated a lower capability for digest<strong>in</strong>g <strong>in</strong>formation orbecom<strong>in</strong>g <strong>in</strong>volved <strong>in</strong> decision-mak<strong>in</strong>g (Simon et al., 2007).A strong <strong>in</strong>terest <strong>in</strong> <strong>in</strong>formation and <strong>in</strong>volvement was also documented amongconsumers with schizophrenia. Positive outcomes were demonstrated, <strong>in</strong>clud<strong>in</strong>gimproved knowledge, higher <strong>in</strong>volvement, and improved social function and<strong>Shared</strong> <strong>Decision</strong>-<strong>Mak<strong>in</strong>g</strong> <strong>in</strong> <strong>Mental</strong> <strong>Health</strong> <strong>Care</strong>:Practice, Research, and Future Directions
17satisfaction. Physicians <strong>in</strong> these studies expressed concern about the decision-mak<strong>in</strong>gcapability of consumers with schizophrenia.Specific studies highlighted by Dr. Wills <strong>in</strong>clude:• A survey of 96 consumers with schizophrenia found most were <strong>in</strong>terested <strong>in</strong>SDM especially <strong>in</strong> regard to medication (Bunn, O’Connor, Tansey, Jones, &St<strong>in</strong>son, 1997);• A randomized control trial of SDM among consumers with schizophrenia <strong>in</strong>Berl<strong>in</strong> found that those <strong>in</strong>volved <strong>in</strong> SDM were more knowledgeable than those<strong>in</strong> usual care (Hamann, Cohen, Leucht, Busch, & Kissl<strong>in</strong>g, 2005; Hamann etal., 2006);• SDM was associated with improved social <strong>in</strong>teraction and satisfaction <strong>in</strong> a2-year randomized control trial of two Swedish community-based treatmentprograms for people with schizophrenia (Malm, Ivarsson, Allebeck, & Falloon,2003); and• An <strong>in</strong>tervention study at Michigan State University of persons with diabeteswho also have depression found improved knowledge, improvement <strong>in</strong> decisionstage, greater satisfaction with decision-mak<strong>in</strong>g, improved <strong>in</strong>volvement,and decreased depression and stress with SDM (Wills, 2006).Dr. Wills reported that the Michigan State University study <strong>in</strong>cluded an analysisof the feasibility of the <strong>in</strong>tervention—a depression decision support booklet. Thebooklet was evaluated as easy to read, and more than 80 percent of participants reportedthat the time required to complete the materials, the amount of <strong>in</strong>formation,and the balance of <strong>in</strong>formation provided were appropriate. The decision-mak<strong>in</strong>gexercises were found to be helpful <strong>in</strong> activat<strong>in</strong>g or clarify<strong>in</strong>g consumers’ th<strong>in</strong>k<strong>in</strong>gabout decisions, and case illustrations of others’ decisions were reported to be veryhelpful. Consumers with more severe depression or lower education levels reportedthat the materials required effort, but were still helpful. Project partners perceivedthe <strong>in</strong>tervention to be a value-added aspect of diabetes self-management educationand described it as a feasible <strong>in</strong>tervention.Liability ConcernsThe doctor-patient relationship is def<strong>in</strong>ed to <strong>in</strong>clude legal and f<strong>in</strong>ancial responsibilitiesand rights. The effect of employ<strong>in</strong>g SDM with<strong>in</strong> a mental health care sett<strong>in</strong>gmust be explored <strong>in</strong> light of these exist<strong>in</strong>g rights and responsibilities. Participants atthe SDM meet<strong>in</strong>g suggested that other models might <strong>in</strong>form new understand<strong>in</strong>gs ofresponsibilities and liability <strong>in</strong> the context of SDM. For example, a tax accountant isa professional with particular expertise hired to provide particular services. The honest<strong>in</strong>put of the consumer, however, is understood to be critical to the accountant’sability to provide those services.<strong>Shared</strong> <strong>Decision</strong>-<strong>Mak<strong>in</strong>g</strong> <strong>in</strong> <strong>Mental</strong> <strong>Health</strong> <strong>Care</strong>:Practice, Research, and Future Directions
- Page 4: iiContentsIntroduction ............
- Page 11 and 12: 5outpatient commitment (Holmes-Rovn
- Page 13 and 14: 7Advantages• Practitioners can be
- Page 15: 9Section 2The Practice of SharedDec
- Page 24: 18Mental health care providers are
- Page 27 and 28: 21want mental health treatment or d
- Page 29: 23Some participants raised concerns
- Page 37 and 38: 31Section 6ConclusionsShared decisi
- Page 39 and 40: 33Fellowes, D., Wilkinson, S., & Mo
- Page 41 and 42: 35Power, A. Kathryn. (July 10, 2007
- Page 43 and 44: 37Appendix AResourcesThis list is p
- Page 45 and 46: 39Appendix BShared Decision-MakingM
- Page 47 and 48: 41Annelle Primm, M.D., M.P.H.Direct
- Page 49 and 50: 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 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 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