Health Service of Murcia, Cartagena Mental Health Centre, Murcia, Spain.
Department of Legal Medicine, Regional Campus of International Excellence "Campus Mare Nostrum," Faculty of Medicine, University of Murcia, Cartagena, Spain.
J Eval Clin Pract. 2019 Dec;25(6):1200-1209. doi: 10.1111/jep.13246. Epub 2019 Aug 2.
RATIONALE, AIMS AND OBJECTIVES: Over the last years, traditional paternalistic model is being questioned. Shared Decision-Making (SDM) model has been proposed as a way to improve patient-physician interaction. Little is known to what extent people with severe mental illness want to be involved in decision-making process. This study evaluates their preferences about making clinical decisions and which variables influence these desires.
One hundred seven patients with DSM diagnoses of bipolar disorder or schizophrenia and 100 Non Psychiatric Comparison (NPC) subjects recruited from mental health and primary care departments completed a self-reported questionnaire about preferences in decision-making process. Demographic and clinical information was obtained through review of available records and the Brief Psychiatric Rating Scale (BPRS).
Patients and NPCs differed as regards their preferences about their participation in medical decisions. NPCs were 18 times more likely to prefer options about their treatment and 2 times more likely to prefer to take medical decisions by their own than psychiatric patients. The best predictors of the preference of a SDM model were a lower BPRS global score and the absence of previous compulsory admissions.
Psychiatric patients more frequently preferred a passive role in the decision-making process. Interventions to promote SDM should be tailored to the values and needs of each patient because not everyone wants to participate to the same degree. We found several factors to take into account in patient engagement in SDM as these populations may be more vulnerable.
背景、目的和目标：近年来，传统的家长式医疗模式受到质疑。共享决策模型（SDM）被提出作为改善医患互动的一种方式。目前尚不清楚有多少患有严重精神疾病的人希望参与决策过程。本研究评估了他们对参与临床决策的偏好，以及哪些变量影响这些愿望。
107 名被诊断为双相情感障碍或精神分裂症的患者和 100 名非精神科对照组（NPC）受试者从精神卫生和初级保健部门招募，完成了一份关于决策过程偏好的自我报告问卷。通过查阅现有记录和简明精神病评定量表（BPRS）获得人口统计学和临床信息。
患者和 NPC 在参与医疗决策的偏好上存在差异。NPC 更倾向于选择治疗方案的可能性是精神病患者的 18 倍，而 NPC 更倾向于自己做出医疗决策的可能性是精神病患者的 2 倍。偏好 SDM 模型的最佳预测因素是 BPRS 总分较低和没有既往强制住院史。
精神科患者在决策过程中更倾向于被动角色。促进 SDM 的干预措施应该根据每个患者的价值观和需求进行定制，因为并非每个人都希望以相同的程度参与。我们发现了一些需要考虑的因素，以促进这些人群的 SDM 参与，因为这些人群可能更容易受到影响。
