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Rovers J, Schönberger L, Loef D, van Eijndhoven P, Verwijk E, Somers M, Dols A, Tendolkar I. Exploring the Decision-Making Process for Electroconvulsive Therapy in Patients With Major Depressive Disorder and Their Relatives After Treatment. J ECT 2025:00124509-990000000-00258. [PMID: 39998858 DOI: 10.1097/yct.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2025]
Abstract
OBJECTIVES Shared decision making is used for reaching medical decisions, also in the management of major depressive disorder (MDD). Electroconvulsive therapy (ECT) is an effective treatment option for patients with severe MDD. However, the decision-making process, specifically the exchange of evidence-based information, for ECT may be hampered by the controversy and stigma surrounding ECT. We aim to explore the experiences of the decision-making process of patients and their relatives who have chosen to receive ECT in order to guide optimization of shared decision making in ECT. METHODS Semistructured interviews were conducted with MDD patients and their relatives who had voluntarily received ECT between 2018-2023 at the Radboud University Medical Center, the Netherlands. The interviews were analyzed by thematic analysis. RESULTS Meaning saturation occurred after 16 interviews. The following 3 major themes emerged: 1) information is key, 2) empowering the decision, and 3) lived experiences with ECT. Participants emphasized the importance of accessible information presented in a calm and stepwise manner. They also identified gaps in desired information, particularly regarding memory loss and difficulty in retaining the given information. Factors empowering the decision included support from family, healthcare professionals, peers, and desperation, while negative factors included stigma, negative images, lack of support, and fear. Lived experiences with ECT might influence a future decision. Positive experiences were improved attitudes, treatment effects, and empathic and involved professionals, while negative aspects included cognitive side effects and lack of follow-up. CONCLUSIONS This study offers insights into factors influencing the decision-making process in patients with MDD that received ECT. It shows possibilities for improving the decision-making process in clinical practice.
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Affiliation(s)
| | - Lieke Schönberger
- From the Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Metten Somers
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Villena A, Hurtado MM, Gómez C, Amor G, Vega A, Morales‐Asencio JM. Users remain overlooked: Shared decision-making processes for people with anxiety disorders. J Psychiatr Ment Health Nurs 2025; 32:203-214. [PMID: 39161272 PMCID: PMC11704998 DOI: 10.1111/jpm.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 07/15/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Patients do not always receive enough information about their diagnosis and their perceived participation in decision-making about their treatment is low. Some participants reported feeling very uncertain when the physician invited them to choose between these options. Others users expressed their satisfaction with the trend away from paternalistic attitudes in the health system. There is a trend towards pharmacological prescription as a first approximation. This contrasts with the recommendations of scientific organizations based on evidence and cost-effectiveness studies on the offer of psychological interventions as the first option. The user groups pointed out that active coping, based on exposure to anxiety-generating situations, made a significant contribution to alleviating their anxiety disorders. However, some of those interviewed rejected this type of intervention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Users diagnosed with anxiety disorders miss more information about the disorder and participation in its treatment. Opposite positions coexist in terms of participation in the choice of treatment. Pharmacological treatment is most commonly the first option offered. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study is an example in itself of the involvement of users in the healthcare process, and therefore placing them at the centre of attention, as reflected in healthcare policies and clinical practice guidelines. It promotes the identification of needs that users diagnosed of anxiety disorders may have, with the aim of putting in place, from healthcare professionals and health services, the necessary supports adapted to these. Mental health nurses are well-positioned to offer support and guidance during the process of involvement and shared decision-making. ABSTRACT INTRODUCTION: An essential aspect of mental health treatment and recovery is the degree of involvement by health service users in the process. AIM/QUESTION Explore the values, demands and preferences of persons diagnosed with anxiety disorders, their participation in the treatment provided, and the response of the health system in this regard. METHODS A qualitative study was conducted, with 51 participants. Nine focus groups and four in-depth interviews took place. RESULTS Three broad categories were identified: (1) diagnosis; (2) treatment options offered and shared decision-making; and (3) coping with the disorder. Sometimes patients do not receive enough information to cover their needs. A trend towards drug prescription as a first approach was observed, while active coping based on exposure to anxiogenic situations was indicated as the most effective option. CONCLUSION Shared decision-making is a necessary aspect of treatment, and the therapeutic process should be adapted to match the service user's preferences, values and needs. IMPLICATIONS FOR THE PRACTICE This research identifies the needs of patients diagnosed with anxiety disorders and promotes, therefore, from healthcare professionals and services, the provision of measures to meet these needs.
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Affiliation(s)
- Amelia Villena
- Mental Health UnitRegional University Hospital of MálagaMálagaSpain
- Faculty of Health SciencesUniversidad de MálagaMálagaSpain
| | - María M. Hurtado
- Mental Health UnitRegional University Hospital of MálagaMálagaSpain
- Faculty of Health SciencesUniversidad de MálagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)Universidad de MálagaMálagaSpain
| | | | - Gisela Amor
- Mental Health UnitRegional University Hospital of MálagaMálagaSpain
| | - Amanda Vega
- Mental Health UnitRegional University Hospital of MálagaMálagaSpain
| | - José Miguel Morales‐Asencio
- Mental Health UnitRegional University Hospital of MálagaMálagaSpain
- Faculty of Health SciencesUniversidad de MálagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)Universidad de MálagaMálagaSpain
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Cella D, Kuharic M, Peipert JD, Bedjeti K, Garcia SF, Yanez B, Hirschhorn LR, Coughlin A, Morken V, O'Connor M, Linder JA, Jordan N, Ackermann RT, Amagai S, Kircher S, Mohindra N, Aggarwal V, Weitzel M, Nelson EC, Elwyn G, Van Citters AD, Barnard C. Shared decision-making and disease management in advanced cancer and chronic kidney disease using patient-reported outcome dashboards. J Am Med Inform Assoc 2024; 31:2190-2201. [PMID: 39093939 DOI: 10.1093/jamia/ocae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/22/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES To assess the use of a co-designed patient-reported outcome (PRO) clinical dashboard and estimate its impact on shared decision-making (SDM) and symptomatology in adults with advanced cancer or chronic kidney disease (CKD). MATERIALS AND METHODS We developed a clinical PRO dashboard within the Northwestern Medicine Patient-Reported Outcomes system, enhanced through co-design involving 20 diverse constituents. Using a single-group, pretest-posttest design, we evaluated the dashboard's use among patients with advanced cancer or CKD between June 2020 and January 2022. Eligible patients had a visit with a participating clinician, completed at least two dashboard-eligible visits, and consented to follow-up surveys. PROs were collected 72 h prior to visits, including measures for chronic condition management self-efficacy, health-related quality of life (PROMIS measures), and SDM (collaboRATE). Responses were integrated into the EHR dashboard and accessible to clinicians and patients. RESULTS We recruited 157 participants: 66 with advanced cancer and 91 with CKD. There were significant improvements in SDM from baseline, as assessed by collaboRATE scores. The proportion of participants reporting the highest level of SDM on every collaboRATE item increased by 15 percentage points from baseline to 3 months, and 17 points between baseline and 6-month follow-up. Additionally, there was a clinically meaningful decrease in anxiety levels over study period (T-score baseline: 53; 3-month: 52; 6-month: 50; P < .001), with a standardized response mean (SRM) of -0.38 at 6 months. DISCUSSION PRO clinical dashboards, developed and shared with patients, may enhance SDM and reduce anxiety among patients with advanced cancer and CKD.
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Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Maja Kuharic
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert J Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Ava Coughlin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Victoria Morken
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL 60141, United States
| | - Ronald T Ackermann
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Saki Amagai
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Nisha Mohindra
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Vikram Aggarwal
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Melissa Weitzel
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Cynthia Barnard
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
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Hormazábal-Salgado R, Whitehead D, Osman AD, Hills D. Person-Centred Decision-Making in Mental Health: A Scoping Review. Issues Ment Health Nurs 2024; 45:294-310. [PMID: 38232185 DOI: 10.1080/01612840.2023.2288181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Person-centred decision-making approaches in mental health care are crucial to safeguard the autonomy of the person. The use of these approaches, however, has not been fully explored beyond the clinical and policy aspects of shared and supported decision-making. The main goal is to identify and collate studies that have made an essential contribution to the understanding of shared, supported, and other decision-making approaches related to adult mental health care, and how person-centred decision-making approaches could be applied in clinical practice. A scoping review of peer-reviewed primary research was undertaken. A preliminary search and a main search were undertaken. For the main search, eight databases were explored in two rounds, between October and November 2022, and in September 2023, limited to primary research in English, Spanish or Portuguese published from October 2012 to August 2023. From a total of 12,285 studies retrieved, 21 studies were included. These research articles, which had mixed quality ratings, focused on therapeutic relationships and communication in decision-making (30%), patients' involvement in treatment decision-making (40%), and interventions for improving patients' decision-making engagement (30%). While there is promising evidence for shared decision-making in mental health care, it is important that healthcare providers use their communicational skills to enhance the therapeutic relationship and engage patients in the process. More high-quality research on supported decision-making strategies and their implementation in mental health services is also required.
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Affiliation(s)
- Raúl Hormazábal-Salgado
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Dean Whitehead
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Abdi D Osman
- College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Danny Hills
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
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