Content and implementation of clinical decisions in the routine care of people with severe mental illness
Abstract
BACKGROUND: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. AIMS: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. METHOD: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. RESULTS: Agreement between patients and staff regarding decision making was moderate (k = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. CONCLUSIONS: A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.
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Patients were rarely involved in the medication choice or given a choice at all during clinical encounters.
“while patients were rarely involved in the medication choice or given a choice at all”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [56]
During clinical encounters, the most frequent decisions taken by clinicians were related to medications and to the severity of symptoms.
“Konrad et al. [56] found that during clinical encounters, the most frequent decisions taken by clinicians were related to medications and to the severity of symptoms”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [56]
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Fiorillo, A., Barlati, S., Bellomo, A., Corrivetti, G., Nicolò, G., Sampogna, G., Stanga, V., Veltro, F., Maina, G., & Vita, A. (2020) · Annals of General Psychiatry · doi:10.1186/s12991-020-00293-4 · Cited by 110 · see citing works
- Authors
- Konrad, J., Loos, S., Neumann, P., Zentner, N., Mayer, B., Slade, M., Jordan, H., De Rosa, C., Del Vecchio, V., Égerházi, A., Nagy, M., Krogsgaard Bording, M., Østermark Sørensen, H., Kawohl, W., Rössler, W., Puschner, B., & for the CEDAR study group
- Affiliations
- Universität Ulm (DE)
- King's College London (GB)
- Department of Psychiatry, University of Naples SUN, Naples, Italy,
- University of Debrecen (HU)
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark, and
- University of Zurich (CH)
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
- Corresponding author
- Konrad, Jana
- Venue
- Journal of Mental Health
- Publisher
- Informa UK Limited
- Published
- 2014-09-04
- Volume
- 24
- Issue
- 1
- Pages
- 15-19
- ISSN
- 0963-8237 (ISSN-L)
- 1360-0567
- OpenAlex
- W2006628188
- Cited by
- 7
- References
- 22
- Citations by year
- 2022: 2 · 2020: 1 · 2017: 2 · 2016: 1 · 2014: 1
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- clinical decision-making, severe mental illness, decision implementation, patient-physician agreement, therapeutic dyad, routine mental health care, social problems, service user perspectives, staff perspectives
- MeSH terms
- Adult, Mental Disorders, Decision Making, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Participation, Physician-Patient Relations
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