Lassman F, Henderson R Claire, Dockery L, Clement S, Murray J, Bonnington O, Farrelly S, Thornicroft G
Health Service and Population Research Department P029, David Goldberg Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
J Occup Rehabil. 2015 Jun;25(2):403-11. doi: 10.1007/s10926-014-9550-5.
Background Decisions about whether to disclose mental health problems to employers are complex, with potential personal, employment and legal implications. Decision aids are evidence based tools, designed to help individuals make specific choices between treatment options. We previously developed a decision aid-Conceal Or ReveAL (CORAL)-to assist service users with decisions about disclosure to employers. As part of a mixed methods exploratory RCT, which demonstrated that the CORAL decision aid was effective in reducing decisional conflict, we aimed to explore its mechanism of action and to optimise the intervention for a future full scale trial. Methods In depth interviews were conducted with individuals receiving vocational support from a mental health trust and participating in the intervention arm of the pilot trial. Thematic analysis was conducted to identify the main themes relating to participants' perceptions of the CORAL decision aid. Results Thirteen participants were interviewed and five main themes were identified: sense of self and values; sense of control; anticipation of disclosure; experience of disclosure; and mechanism of action of the decision aid. Conclusions Data from our 13 participants suggest that the CORAL decision aid acts on several dimensions of decisional conflict: clarifying the pros and cons of different choices; increasing knowledge; structuring the decision making process; and clarifying needs and values. The current study indicated that it would be most effective when delivered by a professional well versed in employment and mental health matters such as a vocational adviser. The need for employers and policymakers to reduce the negative impact of disclosure is also highlighted.
背景 关于是否向雇主披露心理健康问题的决策十分复杂，可能涉及个人、就业和法律等方面的影响。决策辅助工具是基于证据的工具，旨在帮助个人在治疗方案之间做出特定选择。我们之前开发了一种决策辅助工具——隐瞒还是披露（CORAL），以协助服务使用者做出是否向雇主披露的决策。作为一项混合方法探索性随机对照试验的一部分，该试验表明CORAL决策辅助工具在减少决策冲突方面有效，我们旨在探索其作用机制，并为未来的全面试验优化干预措施。方法 对接受心理健康信托机构职业支持并参与试点试验干预组的个人进行了深入访谈。进行了主题分析，以确定与参与者对CORAL决策辅助工具的看法相关的主要主题。结果 对13名参与者进行了访谈，确定了五个主要主题：自我意识和价值观；控制感；披露预期；披露经历；以及决策辅助工具的作用机制。结论 来自我们13名参与者的数据表明，CORAL决策辅助工具在决策冲突的几个维度上发挥作用：阐明不同选择的利弊；增加知识；构建决策过程；以及阐明需求和价值观。当前研究表明，由精通就业和心理健康事务的专业人员（如职业顾问）提供时，它将最为有效。还强调了雇主和政策制定者减少披露负面影响的必要性。
