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

50Both extremes of these models can have significant limitations for people obtainingadequate information, clarifying personal values and preferences, and makingeffective decisions that are more likely to be associated with favorable outcomes. Inan SDM process, the exchange of information is bidirectional, a supportive contextexists for the clarification and sharing of values and preferences, and responsibilityfor decision-making about the options is equally shared between the consumer andcare provider as appropriate and determined by both partners (Charles et al., 1999;Edwards & Elwyn, 2006).Autonomy and SDM. An SDM approach includes an emphasis on respect for theautonomy of an individual, a value that is deeply embedded in traditional Americanculture and many other Western societies. 3 In Western health care, a person’sparticipation in decision-making occurs on a spectrum of traditional to informedchoice models. Research has shown that most people who use Western health careservices prefer the SDM model in which partners engage in a dialog and come to aconsensual decision (Benbassat, Pilpel, & Tidhar, 1998; Elwyn & Edwards, 2001;Murray, Pollack, White, & Lo, 2007a). 4 A representative sample of U.S. physiciansalso showed that 75 percent preferred SDM (Murray, Pollack, White, & Lo, 2007b),although current evidence indicates that SDM has not been widely implementedin practice (Gravel, Legare, & Graham, 2006). Exceptions in which the traditionalmedical (nonautonomous) model can be appropriate are true emergency situations(e.g., severe life-threatening traumatic injury) or instances when a person is totallyunable to interact or process information (e.g., coma, severe cognitive impairment).Models in which only the consumer or the provider makes a decision may be mostappropriate for situations in which there is low uncertainty or conflict in decisionmaking(Frosch & Kaplan, 1999; Whitney, 2003).Research on SDM in Mental HealthOverviewIn mental health care, the practice and study of SDM is just beginning to be addressedand the actual evidence base is currently insufficient to provide strong empiricalsupport for the use of SDM as an evidence-based practice in mental health care(Fenton, 2003; Fischer, 2006; Hamann et al., 2003). Much of the newer researchis international and largely concentrated in Western European countries. Decisionmakingin theory has been applied in health care practice and research since the1960s, but until the 1980s was largely focused on the decision-making of health care3The value on individualism is not universal and may be viewed as irrelevant or represent a counter-culturalvalue in some societies.4Certain other exceptions and debates about the use of SDM are discussed later in this paper.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions