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

73these approaches, people are more satisfied with their care, and more likely to followthrough with therapy (Stevenson, Cox, Britten, & Dundar, 2004; Edwards et al.,2004; Fellowes, Wilkinson, & Moore, 2004). Some studies show improved healthstatus and lowered anxiety (van Dam, van Der, van Den, Ryckman, & Crebolder,2003). A Cochrane Collaboration review (Lewin et al., 2001) indicates that physiciansin structured training programs learn communication skills quickly and retainthem, especially when offered the opportunity for practice with observationalevaluation and feedback. Other systematic reviews show similar results (Coulter &Ellins, 2006).However, the results of both inpatient and outpatient surveys show that one-thirdto one-half of patients indicate they would have liked more involvement in decisionsabout their treatment and care (Coulter, 2006). This apparent gap between expectationsand experience is beginning to be investigated. Clinician barriers to fullyembracing the collaborative approach include both role concerns and skill concerns.Physicians’ and nurses’ perceived barriers to providing evidence-based informationto patients and involving them in decisions, as identified by Ford, Schofield, andHope (2002), include:• Concern about knowledge gaps and limitations of the research evidence;• Concern about their own lack of skills in risk communication;• Belief that many patients could not cope with the information and/or wouldnot want to take responsibility for decision-making;• Fear that patients would tend to choose the most expensive or unaffordableoptions;• Concern about lack of technical support for shared decision-making, e.g., nonavailabilityof risk communication tools or decision aids;• Concern about time constraints within the consultation; and• Concern about disrupting or undermining the doctor-patient relationship(p. 181).To overcome resistance by physicians and other providers, examination and licensurerequirements have become a leverage point to require providers to learn communicationskills. Passing competency examinations in communication skills is nowpart of step three of the examination of the National Board of Medical Examiners.The American Board of Internal Medicine requires demonstration of competency incommunication skills, and other members of the American Board of Medical Specialistsare in the process of adding communication as a basic skill in their specialty.However, even in countries that have widely adopted this approach, thereare continuing concerns expressed by providers. A recent study of clinicians in theShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions