Shared Decision Making (SDM) is a collaborative process between a client and a practitioner, both of whom recognize one another as experts and work together to exchange information and clarify values in order to arrive at a health care decision (Deegan, Rapp, Holter, & Riefer 2008; Elwin et al., 2017).
In SDM, the clinician is an expert in diagnosis and treatment options, while the patient has lived experience expertise in personal preferences, based on personal values and needs. By including patient experiences and patient preferences along with scientific evidence and clinician knowledge, the aim of SDM is to ensure patient-centered decisions that reflect user's needs and work well for each individual patient.
In the Region of Southern Denmark, SDM is a prioritized implementation effort in all hospitals of somatic care and in all the hospitals serving people with mental health issues. Guided by the principle that "the best possible course of treatment is characterized by people with mental illness being met as equal partners with influence on their own treatment" (Psykiatriplanen 2020-2024, Region Syddanmark), SDM is integrated as an overall vision for the mental health services in the region.
Implementation of SDM in the mental health services of the Region of Southern Denmark is ongoing, and gradually the implementation is expected to involve most of the mental health units and teams in the mental health services.
The objective of the project is to establish a basic knowledge on decision-making preferences among mental health professionals by measuring general and specific preferences in different decision-making situations. The aim is also to investigate whether decision-making preferences may change with the SDM implementation. Further, the project aims to detect if there are correlations between different decision-making preferences and knowledge of recovery in mental health providers, and to analyse possible variations of preferences and knowledge of recovery in relation to different background variables, e.g. professional group, age, gender and length of service.
Data and biological material
Preferences for clinical decision-making among mental health practitioners are investigated in both inpatient and outpatient mental health settings by using the Clinical Decision Making Style (CDMS), while knowledge of recovery is measured by using the Recovery Knowledge Inventory (RKI).
The CDMS is a modified version of the Autonomy Preference Index adapted for use in mental health care. It consists of 2 subscales and 21 items in total. The Participation in Decision Making (PD) subscale is 15 questions about preferences for decision-making in different decision situations related to treatment, medication and work conditions. A short case presentation is used in several of the questions, for example: Imagine that a patient is recovering after an acute phase; now the patient wants to return to work, after which a series of questions follow as to who, according to the therapist, should make the decision: The patient alone, mainly the patient, the patient and I together, mainly me, me alone. The Information sub-scale (IN) has six questions on the level of information, to which professionals in the staff version of CDMS must answer how much they agree or disagree with the patient's need for information in different decision situations.
The Recovery Knowledge Inventory (RKI) is 20 questions on the understanding of recovery and recovery processes in people with mental health disorders. The answers are scored 1 (strongly disagree) to 5 (strongly agree). Several items scores must be reversed before calculating the total score. High score indicates high knowledge and understanding of the concept of recovery and the recovery process.
Relevant background information on treatment sites (inpatient, outpatient, child, adolescent or adult service), professional group, age, gender, length of service, and whether the provider has received training in SDM, are collected.
Deegan, P.E., Rapp, C., Holter, M., & Riefer, M. (2008). Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric Services, 59(6), 603-5. doi: 10.1176/ps.2008.59.6.603.
Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., Cochran, N., Frosch, D., Galasiński, D., Gulbrandsen, P., Han, P., Härter, M., Kinnersley, P., Lloyd, A., Mishra, M., Perestelo-Perez, L., Scholl, I., Tomori, K., Trevena, L., Witteman, H. O., ... Van der Weijden, T. (2017). A three-talk model for shared decision making: multistage consultation process. BMJ (Clinical research ed.), 359, j4891. doi.org/10.1136/bmj.j4891.
Psykiatriplanen 2020-2024, Region Syddanmark: https://psykiatrienisyddanmark.dk/om-sygehuset/psykiatriplan-2020-2024