Drivenes Karin, Haaland Vegard Ø, Hauge Yina L, Vederhus John-Kåre, Irgens Audun C, Solli Kristin Klemmetsby, Regevik Hilde, Falk Ragnhild S, Tanum Lars
Sørlandet Hospital, Kristiansand, Norway.
Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway.
Front Psychol. 2020 Mar 24;11:443. doi: 10.3389/fpsyg.2020.00443. eCollection 2020.
A defined goal in mental health care is to increase the opportunities for patients to more actively participate in their treatment. This goal includes integrating aspects of user empowerment and shared decision-making (SDM) into treatment courses. To achieve this goal, more knowledge is needed about how patients and therapists perceive this integration.
To explore patient experiences of SDM, to describe differences between patient and therapist experiences, and to identify patient factors that might reduce SDM experiences for patients compared to the experiences of their therapists.
This cross-sectional study included 992 patients that had appointments with 267 therapists at Sørlandet Hospital, Division of Mental Health during a 1-week period. Both patients and therapists completed the CollaboRATE questionnaire, which was used to rate SDM experiences. Patients reported demographic and treatment-related information. Therapists provided clinical information.
The analysis included 953 patient-therapist responder pairs that completed the CollaboRATE questionnaire. The mean SDM score was 80.7 (SD 20.8) among patients, and 86.6 (SD 12.1) among therapists. Females and patients that did not use medication for mental health disorders reported higher SDM scores than males and patients that used psychiatric medications (83.3 vs. 77.7; < 0.001 and 82.6 vs. 79.8; = 0.03, respectively). Patients with diagnoses involving psychotic symptoms reported lower SDM scores than all the other patients (66.8 vs. 82.3; < 0.001). The probability that a patient would report lower SDM scores than their therapist was highest among patients that received involuntary treatment (OR 3.2, = 0.02), patients with treatment durations longer than 2.2 years (OR 1.9, = 0.001), and patients that required day care or in-patient care (OR 3.2, = 0.01 and OR 3.2, < 0.001, respectively).
We showed that both therapists and patients reported good SDM experiences in decisional situations, which indicated that SDM was implemented well. However, the SDM scores reported by in-patients and patients with prolonged or involuntary treatments were significantly lower than scores reported by their therapists. Our findings suggested that it remains a struggle in mental health care to establish a common understanding between patients and therapists in decisional processes regarding treatments for some patient groups.
精神卫生保健的一个明确目标是增加患者更积极参与治疗的机会。这一目标包括将用户赋权和共同决策（SDM）的各个方面纳入治疗过程。为实现这一目标，需要更多关于患者和治疗师如何看待这种整合的知识。
探讨患者对共同决策的体验，描述患者与治疗师体验之间的差异，并确定与治疗师相比可能会降低患者共同决策体验的患者因素。
这项横断面研究纳入了在1周内于南挪威医院精神卫生科与267名治疗师预约就诊的992名患者。患者和治疗师均完成了CollaboRATE问卷，该问卷用于对共同决策体验进行评分。患者报告了人口统计学和与治疗相关的信息。治疗师提供了临床信息。
分析纳入了953对完成CollaboRATE问卷的患者 - 治疗师应答者对。患者的平均共同决策得分为80.7（标准差20.8），治疗师的平均得分为86.6（标准差12.1）。未使用精神疾病药物的女性和患者的共同决策得分高于使用精神科药物的男性和患者（分别为83.3对77.7；<0.001和82.6对79.8；=0.03）。诊断涉及精神病性症状的患者的共同决策得分低于所有其他患者（66.8对82.3；<0.001）。在接受非自愿治疗的患者（比值比3.2，=0.02）、治疗时长超过2.2年的患者（比值比1.9，=0.001）以及需要日间护理或住院护理的患者（分别为比值比3.2，=0.01和比值比3.2，<0.001）中，患者报告的共同决策得分低于其治疗师的可能性最高。
我们表明，治疗师和患者在决策情境中均报告了良好的共同决策体验，这表明共同决策实施良好。然而，住院患者以及接受长期或非自愿治疗的患者报告的共同决策得分明显低于其治疗师报告的得分。我们的研究结果表明，在精神卫生保健中，对于一些患者群体，在治疗决策过程中，患者和治疗师之间达成共识仍然存在困难。
