Applied Research and Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland.
Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands.
Int J Environ Res Public Health. 2022 Mar 18;19(6):3644. doi: 10.3390/ijerph19063644.
Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals' communication style as well as the patients' personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended.
共同决策在医疗保健中越来越受到关注，可能会提高医疗质量和患者的治疗效果。然而，由于其复杂性，在临床实践中实施共同决策似乎具有挑战性。这项民族志研究旨在更好地了解精神病住院患者和跨专业护理团队在常规跨专业精神病咨询期间如何相互作用。研究数据通过在瑞士一家大型精神病医院的两个不同精神病病房进行参与式观察收集。观察重点是跨专业患者咨询的背景方面、沟通和互动，以及患者参与决策的程度。参与者包括患者、精神科医生、初级医生、护士、心理学家、社会工作者和治疗师。我们观察了 71 次跨专业的精神病咨询，这两个病房在背景（地点和形式）和文化（互动方式）方面都有很大的不同。相反，结果表明，患者参与决策的程度相当，这取决于个人因素，如医疗保健专业人员的沟通方式以及患者主动参与的意愿。与患者讨论的主要话题涉及药物治疗和患者报告的症状。两个病房的医护人员都采用了相当单向的沟通方式。因此，为了促进精神病住院患者的参与，而不是关注背景因素，咨询应该遵循特定的议程，并强烈建议为所有相关方促进双向沟通方式。
