Share This Article:

Preferences for participation in shared decision making of psychiatric outpatients with affective disorders

Abstract Full-Text HTML Download Download as PDF (Size:119KB) PP. 16-23
DOI: 10.4236/ojpsych.2014.41004    3,038 Downloads   5,183 Views   Citations

ABSTRACT

Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Cuevas, C. and Peñate, W. (2014) Preferences for participation in shared decision making of psychiatric outpatients with affective disorders. Open Journal of Psychiatry, 4, 16-23. doi: 10.4236/ojpsych.2014.41004.

References

[1] Edwards, A. and Elwyn, G. (2009) Shared decisionmaking in health care: Achieving evidence-based patient choice. 2nd Edition, Oxford University Press, Oxford, New York.
[2] Charles, C., Gafni, A. and Whelan, T. (1997) Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine, 44, 681-692. http://dx.doi.org/10.1016/S0277-9536(96)00221-3
[3] Elwyn, G., Edwards, A., Gwyn, R. and Grol, R. (1999) Towards a feasible model for shared decision making: Focus group study with general practice registrars. BMJ, 319, 753-756. http://dx.doi.org/10. 1136/bmj.319.7212.753
[4] Makoul, G. and Clayman, M.L. (2006) An integrative model of shared decision making in medical encounters. Patient Education and Counseling, 60, 301-312. http://dx.doi.org/10.1016/j.pec. 2005.06.010
[5] Horne, R. and National Coordinating Centre for NHS Service Delivery and Organisation (Great Britain) (2005) Concordance, adherence and compliance in medicine taking: Report for the National Coordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO). NCCSDO, London.
[6] De Las Cuevas, C. (2011) Compliance, adherence and concordance in medicine taking of psychiatric patients. Current Clinical Pharmacology, 6, 71-73. http://dx.doi.org/10.2174/157488411796151165
[7] Sabaté, E. (2003) Adherence to long-term therapies evidence for action. World Health Organization, Geneva.
[8] Trevena, L. and Barratt, A. (2003) Integrated decision making: Definitions for a new discipline. Patient Education and Counseling, 50, 265-268. http://dx.doi.org/10.1016/S0738-3991(03)00047-8
[9] Groopman, J.E. and Hartzband, P. (2011) Your medical mind: How to decide what is right for you. Penguin Press, New York.
[10] Levinson, W., Kao, A., Kuby, A. and Thisted, R.A. (2005) Not all patients want to participate in decision making. A national study of public preferences. Journal of General Internal Medicine, 20, 531-535. http://dx.doi.org/10.1111/j.1525-1497.2005.04101.x
[11] Guy, W. (1976) Early Clinical Drug Evaluation Unit (ECDEU) assessment manual for psychopharmacology. National Institute of Mental Health, Bethesda.
[12] Hogan, T.P., Awad, A.G. and Eastwood, R. (1983) A self-report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity. Psychological Medicine, 13, 177-183.
http://dx.doi.org/10.1017/S0033291700050182
[13] Hogan, T.P. and Awad, A.G. (1992) Subjective response to neuroleptics and outcome in schizophrenia: A re-examination comparing two measures. Psychological Medicine, 22, 347-352. http://dx.doi.org/10.1017/S0033291700030282
[14] Vieta, E., Blasco-Colmenares, E., Figueira, M.L., Langosch, J.M., Moreno-Manzanaro, M., Medina, E. and WAVE-bd Study Group (2011) Clinical management and burden of bipolar disorder: A multinational longitudinal study (WAVE-bd study). BMC Psychiatry, 11, 58. http://dx.doi.org/10. 1186/1471-244X-11-58
[15] Horne, R., Weinman, J. and Hankins, M. (1999) The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychology and Health, 14, 1-24. http://dx.doi.org/10.1080/08870449908407311
[16] De las Cuevas, C., Rivero-Santana, A., Perestelo-Pérez, L., González-Lorenzo, M., Pérez-Ramos, J. and Sanz, E.J. (2011) Adaptation and validation study of the beliefs about medicines questionnaire in psychiatric outpatients in a community mental health setting. Human Psychopharmacology: Clinical and Experimental, 26, 140-146. http://dx.doi.org/10.1002/hup.1185
[17] Horne, R. and Weinman, J. (1999) Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47, 555-567. http://dx.doi.org/10.1016/S0022-3999(99)00057-4
[18] Beléndez, M., Hernández, A., Horne, R. and Weinman, J. (2007) Evaluación de las creencias sobre el tratamiento: Validez y fiabilidad de la versión espa?ola del Beliefsabout Medicines Questionnaire. International Journal of Health & Clinical Psychology, 7, 767-779.
[19] Mahler, C., Hermann, K., Horne, R., Jank, S., Haefeli, W.E. and Szecsenyi, J. (2012) Patients’ beliefs about medicines in a primary care setting in Germany. Journal of Evaluation in Clinical Practice, 18, 409-412. http://dx.doi.org/10.1111/j.1365-2753.2010.01589.x
[20] Raynor, D.K., Thistlethwaite, J.E., Hart, K. and Knapp, P. (2001) Are health professionals ready for the new philosophy of concordance in medicine taking? International Journal of Pharmacy Practice, 9, 81-84. http://dx.doi.org/10.1111/j.2042-7174.2001.tb01034.x
[21] De las Cuevas, C., Rivero, A., Perestelo-Perez, L., Gonzalez, M., Perez, J. and Pe?ate, W. (2011) Psychiatric patients’ attitudes towards concordance and shared decision making. Patient Education and Counseling, 85, e245-e250. http://dx.doi.org/10.1016/j.pec.2011.02.015
[22] Beck, A.T., Steer, R.A., Ball, R. and Ranieri, W. (1966) Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67, 588-597.
http://dx.doi.org/10.1207/s15327752jpa6703_13
[23] Sanz, J., García, M.P., Espinosa, R., Fortún, M. and Vázquez, C. (2005) Adaptación espa?ola del Inventario para la Depresión de Beck-II (BDI-II): 3. Propiedades psicométricas en pacientes con trastornos psicológicos. Clínica y Salud, 16, 121-142.
[24] Hollon, S.D., Kendall, P.C. and Lumry, A. (1986) Specificity of depressotypic cognitions in clinical depression. Journal of Abnormal Psychology, 95, 52-59. http://dx.doi.org/10.1037/0021-843X.95. 1.52
[25] Krantz, S.E. and Rude, S.S. (1984) Depressive attributions: Selection of different causes or assignment of dimensional meanings? Journal of Personality and Social Psychology, 47, 193-203. http://dx.doi.org/10.1037/0022-3514.47.1.193
[26] Rude, S.S., Krantz, S.E. and Rosenhan, D.L. (1988) Distinguishing the dimensions of valence and belief consistency in depressive and nondepressive information processing. Cognitive Therapy and Research, 12, 391-407. http://dx.doi.org/10.1007/BF01173306
[27] Rude, S.S., Wenzlaff, R.M., Gibbs, B. and Vane, J. (2002) Negative processing biases predict subsequent depressive symptoms. Cognition and Emotion, 16, 423-440. http://dx.doi.org/10.1080/ 02699930143000554
[28] Benbassat, J., Pilpel, D. and Tidhar, M. (1998) Patients’ preferences for participation in clinical decision making: A review of published surveys. Behavioral Medicine, 24, 81-88. http://dx.doi.org/10. 1080/08964289809596384
[29] Carlsen, B. and Aakvik, A. (2006) Patient involvement in clinical decision making: The effect of GP attitude on patient satisfaction. Health Expect, 9, 148-157. http://dx.doi.org/10.1111/j.1369-7625. 2006.00385.x

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.