The impact of shared decision-making on the treatment of anxiety and depressive disorders: systematic review

Exploring the Decision-Making Process for Electroconvulsive Therapy in Patients With Major Depressive Disorder and Their Relatives After Treatment

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.

Users remain overlooked: Shared decision-making processes for people with anxiety disorders

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.

Shared decision-making and disease management in advanced cancer and chronic kidney disease using patient-reported outcome dashboards

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.

Person-Centred Decision-Making in Mental Health: A Scoping Review

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.

Decision aids linked to the recommendations in clinical practice guidelines: results of the acceptability of a decision aid for patients with generalized anxiety disorder

Background

Generalized anxiety disorder (GAD) is one of the most prevalent mental health problems. Patients with GAD have unmet needs related to the information received about their disorder, its treatments and their participation in the decision-making process. The aim of this study is to develop and assess the acceptability of a patient decision aid (PtDA) for patients with GAD.

Method

The PtDA was developed following the International Patient Decision Aid Standards. The recommendations of the Spanish clinical practice guideline (CPG) for patients with GAD were used as the basis. The first prototype was developed by an expert committee, further improvements were made with patients (n = 2), clinical experts (n = 13) and the project management group (n = 7). The acceptability of this second draft was assessed by patients non-involved in the previous phases (n = 11).

Results

The final PtDA version included a brief description of GAD and its treatments. Most participants agreed that the PtDA was easy to use, visually appealing and useful. At least half of the participants learned new things about treatments and adverse effects.

Conclusions

A PtDA was developed for patients with GAD based on recommendations from the Spanish CPG. It was improved and accepted by patients and clinical experts involved. An evaluation of its effectiveness on the shared decision-making process during the clinical encounter is planned.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01899-2.