Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
BMJ Open. 2022 May 30;12(5):e057300. doi: 10.1136/bmjopen-2021-057300.
To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units.
VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data.
34 VHA inpatient mental health units located in every geographical region of the USA.
55 treatment team members.
Our results identified an overarching theme of 'power-sharing' that describes participants' conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1) patients are excluded from treatment decisions; (2) patients are informed of treatment decisions but have limited influence on the decision-making process; and (3) patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy.
Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients' self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.
在退伍军人健康管理局（VHA）住院精神保健病房中，从康复导向型护理的角度研究共享决策（SDM）的理解和实践。
根据康复导向型急性住院量表（RAIN）对 VHA 住院精神保健病房进行评分。药物 SDM 项的 RAIN 评分用于对每个站点进行从低到高的排名。选择排名最高的前 7 家和排名最低的后 8 家机构（n=15），采用混合方法进行进一步分析，包括定性访谈、观察记录和定量数据。
美国每个地理区域的 34 个 VHA 住院精神保健病房。
55 名治疗团队成员。
我们的研究结果确定了一个总的主题“权力共享”，它描述了参与者对药物决策的概念化和实践。从访谈和观察数据中得出了三种权力共享水平：（1）患者被排除在治疗决策之外；（2）患者被告知治疗决策，但对决策过程的影响力有限；（3）患者和提供者协作并共同参与药物决策。将访谈与观察数据进行比较，只有观察数据表明，这些主题在 RAIN SDM 项目评分上区分了高低评分的站点。除了一个最高评分的站点，其他站点都表示共享了药物决策过程，而最低评分的站点则反映了大多数情况下没有权力共享。此外，我们的研究结果强调了促进 SDM 实施的三个关键因素：将退伍军人纳入治疗团队、对患者进行教育以及尊重患者自主权。
SDM 的实施在急性住院精神保健病房中似乎是可行的。尽管大多数参与者对 SDM 有很好的了解，但这些知识并不总是转化为实践，这支持了对 SDM 持续实施支持的需要。其他背景因素强调了患者自我决定作为 SDM 指导原则的价值，突出了支持、赋权和自主生成环境的作用。
