1 University of Oxford, Oxford, United Kingdom.
2 RMIT University, Melbourne, Victoria, Australia.
Qual Health Res. 2018 May;28(6):1002-1015. doi: 10.1177/1049732318762371. Epub 2018 Mar 20.
Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the "Inward Expert," the "Outward Entrustor," the "Self-Aware Observer," and the "Social Integrator." These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users' needs and preferences.
支持性决策（SDM）是指导精神卫生服务提供的原则，旨在提高人们就其护理做出明智决策的能力。了解不同的个体需求对于其成功至关重要。基于对澳大利亚 29 名被诊断患有精神疾病的人的叙述性访谈，我们研究了参与者如何反思自己的 SDM 经验。我们发现，参与者对精神健康专业知识、自身经验和能动性的概念化，以及他们对依赖和独立的不同需求，影响了他们与精神卫生从业者的关系。这些因素反过来又影响了他们对 SDM 的期望。出现了四种叙述立场：“内在专家”、“外在委托者”、“自我意识观察者”和“社会整合者”。这些定位影响了参与者预期和认为最有用的支持类型或风格。我们的研究结果与制定有效的 SDM 方法有关，这些方法考虑到了服务使用者的需求和偏好。
