Health Services Research & Development

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Etingen B, Hill JN, Miller LJ, Schwartz A, LaVela SL, Jordan N. An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective. Military medicine. 2019 Mar 1; 184(Suppl 1):467-475.
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Abstract: OBJECTIVE: To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). METHODS: Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. RESULTS: While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers' clinical knowledge/expertise, knowledge of the facility's treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. CONCLUSION: These results offer a preliminary understanding of VA MH providers' facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.