Bjønness Stig, Grønnestad Trond, Storm Marianne
Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Norway.
Department of Psychiatry, Stavanger University Hospital, Norway.
Scand J Child Adolesc Psychiatr Psychol. 2020 Sep 19;8:139-148. doi: 10.21307/sjcapp-2020-014. eCollection 2020.
Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services.
To explore adolescents' experiences with user participation and shared decision-making in mental healthcare inpatient units.
We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis.
Five themes were identified, representing the adolescents' view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized.
Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents' engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents' participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.
青少年有权参与影响其医疗保健的决策。需要更多知识来提供既适合青少年又符合政策的优质医疗服务。共同决策有可能将用户参与和循证治疗结合起来。研究和政府政策强调共同决策是高质量精神卫生保健服务的关键。
探讨青少年在精神科住院病房中参与用户参与和共同决策的经历。
在这项定性研究中，我们对16至18岁的青少年进行了10次深入访谈。参与者被收治于挪威的四家精神科住院诊所。对访谈记录进行定性内容分析。
确定了五个主题，代表了青少年对获得信任、获得帮助、被理解、被诊断和贴上标签、被推动以及制定个性化治疗计划的看法。心理教育信息、相互信任以及患者与治疗师之间的治疗关系被认为是共同决策的先决条件。对于青少年来说，被贴上诊断标签或被迫接受他们没有发起或控制的治疗方案往往会引发强烈的抵触情绪。强调了青少年在入院时的参与、参与治疗计划、个性化治疗以及医疗保健专业人员之间的协作。
建议在青少年住院前制定参与和介入的常规流程。共同决策有可能提高青少年的参与度，并减少非自愿治疗和再次入住住院诊所的发生率。在本研究中，共同决策与赋权相关，而与标准化决策工具的关联较小。被医疗保健专业人员贴上标签并主导可能是青少年参与治疗的障碍。我们建议减少对诊断的重视，更多地关注个性化治疗。
