Etingen Bella, Hill Jennifer N, Miller Laura J, Schwartz Alan, LaVela Sherri L, Jordan Neil
Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL.
Women's Mental Health, Mental Health Service Line, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL.
Mil Med. 2019 Mar 1;184(Suppl 1):467-475. doi: 10.1093/milmed/usy407.
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).
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.
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.
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.
描述退伍军人事务部（VA）参与创伤后应激障碍（PTSD）治疗规划的心理健康（MH）提供者当前采用的做法，以支持PTSD退伍军人参与共同决策（SDM）。
在一家大型VA机构对MH提供者（n = 9）进行了半结构化访谈，进行录音并逐字转录。在已发表的关于MH护理中SDM组成部分的描述的指导下，对转录本进行了演绎分析。
在讨论与患者组建一个有凝聚力的团队时，提供者指出建立融洽关系和评估治疗准备情况的重要性。提供者的临床知识/专业技能、对机构治疗选择的了解、对如何在VA MH护理系统中进行操作的了解以及患者因素（目标/偏好、影响治疗参与的因素）在患者和提供者交换信息时被认为是重要的考虑因素。在协商治疗计划时，提供者表示对话应包括治疗建议和同时进行个性化的机会。他们还强调了讨论以敲定双方都同意的、由患者和提供者共同参与制定的治疗计划并衡量治疗效果的重要性。
这些结果为VA MH提供者促进PTSD护理的SDM提供了初步理解。研究结果可能为希望让PTSD患者参与SDM的MH提供者提供见解。
