Klingaman Elizabeth A, Medoff Deborah R, Park Stephanie G, Brown Clayton H, Fang Lijuan, Dixon Lisa B, Hack Samantha M, Tapscott Stephanie L, Walsh Mary Brighid, Kreyenbuhl Julie A
Mental Illness Research, Education, and Clinical Center, VA Capitol Health Care Network (VISN 5).
Department of Psychiatry, University of Maryland School of Medicine.
Psychiatr Rehabil J. 2015 Sep;38(3):242-8. doi: 10.1037/prj0000114. Epub 2015 Feb 9.
Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction.
Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction.
Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction.
When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship.
尽管不满是患有严重精神疾病的患者不再接受门诊精神科治疗的主要原因，但对于他们对药物管理就诊满意度的预测因素知之甚少。本研究的主要目的是探讨患者对共同决策的偏好维度（即对了解自身精神疾病知识的偏好、被提供并询问其对治疗方案的意见以及参与治疗决策）和治疗关系（即积极协作和临床医生的输入类型）与就诊满意度之间的关系。
参与者为228名患有严重精神疾病的退伍军人，他们在就诊后立即完成了一份19项的自我报告问卷，评估对开药医生就诊的满意度（共524次评估）。在这种相关性设计中，采用具有受限最大似然估计程序的三级混合模型来检验共同决策偏好和治疗联盟作为就诊满意度的预测因素。
参与治疗决策的偏好是与满意度相关的共同决策的独特组成部分，即患者越希望参与，满意度越低。积极协作和开药医生的输入与更高的就诊满意度相关。
当患有严重精神疾病的患者表达参与共同决策的偏好时，仅提供信息和治疗方案可能并不足够；开药医生应关注患者对参与实际治疗决策的兴趣。应在良好的治疗关系背景下，根据患者对共同决策的偏好进行治疗方法的评估和调整。
