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

74Netherlands found that while doctors accept the general idea, they feel that their capacityto structure and manage the clinical encounter is somewhat compromised bycommunication skills guidelines they are required to follow. Veldhuijzen et al. (2007)found that while physicians accepted a positive effect on the quality of medical care,and were aware that communication guidelines define best practices, actual adherenceto communication guidelines remains low despite participation in intensivecommunication skill training. Barriers most frequently cited by general practitionersfocused on lack of fit with the workflow in their day-to-day practice. They also feltthe guidelines were rigid and inefficient, and misconstrued the basic reasons patientsconsult a doctor. Here, as elsewhere, the proposition that patients come to doctorsfor advice and cure was felt to be violated by the drive to SDM.While SDM continues to grow in use, it remains difficult for clinicians, trained togive advice, to embrace shared decision-making in a way they feel is appropriateand responsible. Many feel that there is a basic conflict between their duties of beneficenceand of supporting patient autonomy. Hammond, Bandak, and Williams(1999), in studying perceptions of unilateral versus equalitarian role functions fornurses, physicians, and consumers in a psychiatric facility, found concern about retainingauthority also contributed to the lack of implementation of collaborativedecision-making, even though clinicians supported the general idea.Interventions that teach communication skills to consumers have also been tested.Results show that people taught to ask questions (with and without prompt sheets)and to share in decisions, show improved knowledge and recall of what was saidduring the visit, usually with no increase in time spent in the encounter. However,the results with regard to patient satisfaction, medication adherence, and treatmentoutcomes are mixed in these interventions (Stevenson et al., 2004; Gaston & Mitchell,2005; Harrington, Noble, & Newman, 2004; Griffin et al., 2004; Scott et al.,2003). The most effective interventions have directed intervention simultaneously toboth parties in the encounter, and provided external reminders (Kennedy, Robinson,Hann, Thompson, & Wilkin, 2003).Patient Decision AidsPatient decision aids (DAs), also called decision support tools, are evidence-basedinformation tools designed to assist consumers and providers to discuss the pros andcons of treatment or screening. This includes consumers’ own personal priorities andvalues for both the amount of gain that can be obtained from treatment and the costin terms of side effects as well as money. This background information is designedto encourage a deliberative process in the clinical encounter in arriving at a decisionabout intervention. DAs are focused on specific clinical problems, synthesizing thebest available evidence on treatment or screening options in ways that encourageShared Decision-Making in Mental Health Care: Practice, Research, and Future Directions