Shared decision making for a person with a psychiatric disorder
Shared decision making enables doctors and patients to make health decisions in partnership, informed by the best available evidence and the patient’s values and preferences.
Patients who take part in shared decision making have a more accurate understanding of the benefits and harms of the available treatment options.
A shared decision-making approach should be used when discussing treatment options for the patient’s psychiatric disorder. Shared decision making promotes engagement in the therapeutic process, empowerment and increased adherence to treatment decisions. The clinician’s role in the shared decision-making process is outlined in Steps in the shared decision-making process for a patient with a psychiatric disorder.
If a consumer wellness plan or similar advance care directive is available, this may also be used to assist in shared decision making. A consumer wellness plan (also referred to as a Wellness Recovery Action Plan) contains information about a patient’s choices and preferences for the ongoing care of their mental health, particularly in terms of symptom management, relapse prevention and crisis planning.
Treatment decision aids are used widely in other areas of medicine to facilitate shared decision making, but are not yet standard practice for psychiatric disorders1.
- Discuss with the patient about how they want to make decisions about their care and who they would like involved.
- Determine their preferred form of information (eg verbal, written).
- Exchange information with the patient about their psychiatric disorder—the clinician (and potentially the patient) provide information about possible treatment options, outlining potential harms and benefits. Consider any information the patient provides. Encourage them to express their preferences according to their values and experience—their goals of treatment may not be concordant with the clinician’s and should be explored.
- Allow time and opportunity for deliberating, discussing and conferring treatment decisions. This may involve discussions with significant others, family members, carers or other healthcare providers.
- Encourage and assist the patient to develop a consumer wellness plan or similar advance care directive that outlines their choices and preferences for the ongoing care of their mental health.
- Where possible, select treatment options that are satisfactory to the patient and consistent with their values and preferences.
- Provide opportunity to review decisions at a later date.
- Headspace Evidence Summary: Shared decision making (SDM) for mental health—what is the evidence? [URL]: discusses shared decision making in the context of young people with mental health issues.
- The International Patient Decision Aids Standards (IPDAS) have guidance on quality standards for decision aids.