Drivers of shared decision making in inpatient psychiatry: An exploratory survey of patients' and multi-disciplinary team members' perspectives.

Cheung EH, Petersen E, Zhang L, Wilkerson C, Barceló NE, Soderlund PD, Yerstein M, Wells K. Drivers of shared decision making in inpatient psychiatry: An exploratory survey of patients' and multi-disciplinary team members' perspectives. General hospital psychiatry. 2022 Aug 30; 79:7-14.

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Abstract:

OBJECTIVE: To assess the prevalence and predictors of Shared Decision Making (SDM) in an adult, inpatient psychiatric setting. METHOD: Multi-disciplinary clinician focus groups and patient pre-testing informed the development of a survey on 4 SDM and 11 factors hypothesized to interfere with SDM. The survey was administered to 89 adult inpatients (80% response rate) and their treatment team psychiatrists, nurses, and social workers (n  =  338 ratings, 95% response rate). Group differences and predictors were estimated using t and F-tests. RESULTS: Patients' mean SDM score (n  =  64, standardized Cronbach alpha  =  0.858) was 3.35 ± 1.13 (5  =  highest agreement), and correlated with overall satisfaction with care (n  =  61, r  =  0.399, p  =  0.001). Patients' disagreement with clinician's diagnosis (44% of patients) correlated with lower SDM ratings by patients (t  =  2.55, df  =  62, p  =  0.013) and by clinicians (t  =  2.99, df  =  69, p  =  0.004). Psychotic diagnoses were not a significant determining factor for SDM. Overall, clinicians rated SDM more favorably than patients (t  =  -5.43, df  =  63, p  <  0.001), with nurses and social workers rating SDM higher than physicians (p  <  0.001). CONCLUSIONS: Diagnostic agreement / disagreement is a key predictor of SDM for patients and clinicians, while presence of psychosis is not. SDM was rated higher by clinicians than patients. SDM ratings vary significantly between clinical disciplines.