Book contents
- Clinical Reasoning and Decision-Making in Psychiatry
- Reviews
- Clinical Reasoning and Decision-Making in Psychiatry
- Copyright page
- Contents
- Foreword
- Preface
- 1 Making Sense of the Senseless: How to Gather and Organize Pertinent Information
- 2 The Approach to Diagnostic Ambiguity
- 3 What the Patient Isn’t Telling You: When Seeing Is Not Believing
- 4 Shared Decision-Making
- 5 Deciding on Appropriate Treatment Modalities: Medication, Psychotherapy, Hospitalization, and Other Levels of Care
- 6 Measurement-Based Care and Applying Statistical Concepts to the Individual Patient
- 7 Hypothesis-Testing and Crafting Patient-Specific Decision Trees
- 8 Decision Points in Iterative Pharmacotherapy
- 9 Hierarchical and Complex Pharmacotherapy Decision-Making
- 10 Prioritizing the Components of Any Decision-Making Model
- Index
- References
4 - Shared Decision-Making
Published online by Cambridge University Press: 25 March 2024
Book contents
- Clinical Reasoning and Decision-Making in Psychiatry
- Reviews
- Clinical Reasoning and Decision-Making in Psychiatry
- Copyright page
- Contents
- Foreword
- Preface
- 1 Making Sense of the Senseless: How to Gather and Organize Pertinent Information
- 2 The Approach to Diagnostic Ambiguity
- 3 What the Patient Isn’t Telling You: When Seeing Is Not Believing
- 4 Shared Decision-Making
- 5 Deciding on Appropriate Treatment Modalities: Medication, Psychotherapy, Hospitalization, and Other Levels of Care
- 6 Measurement-Based Care and Applying Statistical Concepts to the Individual Patient
- 7 Hypothesis-Testing and Crafting Patient-Specific Decision Trees
- 8 Decision Points in Iterative Pharmacotherapy
- 9 Hierarchical and Complex Pharmacotherapy Decision-Making
- 10 Prioritizing the Components of Any Decision-Making Model
- Index
- References
Summary
Thus far we have discussed how clinicians are the primary if not sole evaluators and decision-makers when it comes to devising treatment recommendations. Shared decision-making (SDM) is a not-so-new but increasingly recognized form of patient-centered care in which a patient and their clinician actively collaborate to determine which treatment options are most consistent with the patient’s own values, priorities and goals. As described originally by Charles et al. (1997) and later expanded on by Elwyn et al. (2012), an SDM model first involves introducing choice followed by describing options (sometimes using patient decision-support tools – such as charts, graphs, brochures, interactive websites, or audiovisual materials) followed by helping patients explore their preferences in order to make the best decisions for them. Greater focus is placed on the patient’s own narrative and personal experience as influencing treatment decisions, rather than on general diagnostic issues or outcomes.
- Type
- Chapter
- Information
- Clinical Reasoning and Decision-Making in Psychiatry , pp. 80 - 111Publisher: Cambridge University PressPrint publication year: 2024
References
Appelbaum, PS, Grisso, T.Assessing patients’ capacities to consent to treatment. N Engl J Med 1988; 318: 1635–1638CrossRefGoogle Scholar
Berwick, DM.A user’s manual for the IOM’s ‘Quality Chasm’ report. Health Aff (Millwood) 2002; 21: 80–90CrossRefGoogle ScholarPubMed
Calabrese, JR, Durgam, S, Satlin, A, et al.Efficacy and safety of lumateperone for major depressive episodes associated with bipolar I or bipolar II disorder: A phase 3 randomized placebo-controlled trial. Am J Psychiatry 2021; 178: 1098–1106CrossRefGoogle ScholarPubMed
Charles, C, Gafni, A, Whelan, T.Shared decision-making in the medical encounter: What does it mean? (Or it takes at least two to tango). Soc Sci Med 1997; 44: 651–661CrossRefGoogle ScholarPubMed
Elwyn, G, Frosch, D, Thomson, R, et al.Shared decision making: A model for clinical practice. J Gen Intern Med 2012; 27: 1361–1367CrossRefGoogle Scholar
Emanuel, EJ, Pearson, SD.Physician autonomy and health care reform. JAMA 2012; 307: 367–368CrossRefGoogle ScholarPubMed
Garriga, M, Pacchiarotti, I, Kasper, S, et al.Assessment and management of agitation in psychiatry. World J Biol Psychiatry 2016; 17: 86–128CrossRefGoogle ScholarPubMed
Geddes, JR, Gardiner, A, Rendell, J, et al.Comparative evaluation of quetiapine plus lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in bipolar depression (CEQUEL): A 2 × 2 factorial randomised trial. Lancet Psychiatry 2016; 3: 31–39CrossRefGoogle Scholar
Gold, A, Lichtenberg, P.The moral case for the clinical placebo. J Med Ethics 2014; 40: 219–224CrossRefGoogle ScholarPubMed
Grof, P, Duffy, A, Cavazzoni, P, et al.Is response to prophylactic lithium a familial trait? J Clin Psychiatry 2002; 63: 942–947CrossRefGoogle ScholarPubMed
Hamann, J, Cohen, R, Leucht, S, et al.Do patients with schizophrenia wish to be involved in decisions about their medical treatment? Am J Psychiatry 2005; 162: 2382–2384CrossRefGoogle ScholarPubMed
Hamann, J, Mendel, R, Reiter, S, et al.Why do some patients with schizophrenia want to be engaged in medical decision making and others do not? J Clin Psychiatry 2011a; 72: 1636–1543CrossRefGoogle ScholarPubMed
Hamann, J, Mendel, R, Meier, A, et al.“How to speak to your psychiatrist”: Shared decision-making training for inpatients with schizophrenia. Psych Serv 2011b; 62: 1218–1221CrossRefGoogle ScholarPubMed
Jeste, DV, Saks, E.Decisional capacity in mental illness and substance use disorders: Empirical database and policy implications. Behav Sci Law 2006; 24: 607–628CrossRefGoogle ScholarPubMed
Kelley, JM, Kaptchuk, TJ, Cusin, C, et al.Open label placebo for major depressive disorder: A pilot randomized controlled trial. Psychother Psychosom 2012; 81: 312–314CrossRefGoogle ScholarPubMed
Kemp, DE, Ganocy, SJ, Brecher, M, et al.Clinical value of early partial symptomatic improvement in the prediction of response and remission during short-term treatment trials in 3369 subjects with bipolar I or II depression. J Affect Disord 2011; 130: 171–179CrossRefGoogle ScholarPubMed
Leucht, S, Busch, R, Kissling, W, et al.Early prediction of antipsychotic nonresponse among patients with schizophrenia. J Clin Psychiatry 2007; 68: 352–360CrossRefGoogle ScholarPubMed
Makoul, G, Clayman, ML.An integrative model of shared decision making in medical encounters. Patient Educ Couns 2006; 60: 301–312CrossRefGoogle ScholarPubMed
Murray, H, Wortzel, HS.Psychiatric advance directives: Origins, benefits, challenges, and future directions. J Psychiatr Pract 2019; 25: 303–307CrossRefGoogle ScholarPubMed
Papakostas, GI, Perlis, RH, Scalia, MJ, et al.A meta-analysis of early sustained response rates between antidepressants and placebo for the treatment of major depressive disorder. J Clin Psychopharmacol 2006; 26: 56–60CrossRefGoogle ScholarPubMed
Pilarinos, A, Barker, B, Nosova, E, et al.Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada. Addiction 2020; 115: 97–106CrossRefGoogle ScholarPubMed
Pollack, MH, Rappaport, MH, Fayyad, R, et al.Early improvement predicts endpoint remission status in sertraline and placebo treatments of panic disorder. J Psychiatr Res 2002; 36: 229–236CrossRefGoogle ScholarPubMed
Ripoll, L.Psychopharmacologic treatment of borderline personality disorder. Dialogues Clin Neurosci 2013; 15: 213–224CrossRefGoogle ScholarPubMed
Rosenblat, JD, Simon, GE, Sachs, GS, et al.Factors that impact treatment decisions: Results from an online survey of individuals with bipolar and unipolar depression. Prim Care Companion CNS Disord 2018; 20: 18m02340CrossRefGoogle ScholarPubMed
Rutherford, BR, Wall, MM, Brown, PJ, et al.Patient expectancy as a mediator of placebo effects in antidepressant clinical trials. Am J Psychiatry 2017; 174: 135–142CrossRefGoogle ScholarPubMed
Rynn, M, Khalid-Kahn, S, Garcia-Espana, JF, et al.Early response and 8-week treatment outcome in GAD. Depress Anxiety 2006; 23: 461–465CrossRefGoogle ScholarPubMed
Samara, MT, Leucht, C, Leeflang, MM, et al.Early improvement as a predictor of later response to antipsychotics in schizophrenia: A diagnostic test review. Am J Psychiatry 2015; 172: 617–629CrossRefGoogle ScholarPubMed
Schwartz, RS.The use of ultimatums in psychiatric care. Hosp Comm Psychiatry 1990; 41: 1242–1245Google ScholarPubMed
Shay, LA, Lafata, JE.Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making 2015; 35: 114–131CrossRefGoogle ScholarPubMed
Stacey, D, Bennett, CL, Barry, MJ, et al.Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011; 10: CD001431Google Scholar
United States President’s Commission.Making Health Care Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient–Practitioner Relationship. Washington DC: President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1982Google Scholar
van der Loos MLM, Mulder, PGH, GThM, Hartong, et al.Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: A multicenter, double-blind, placebo-controlled trial. J Clin Psychiatry 2009; 70: 223–231Google Scholar
Weisner, C, Hinman, A, Lu, Y, et al.Addiction treatment ultimatums and US health reform: A case study. Nordik Alkohol Nark 2010; 27: 685–698Google ScholarPubMed
Wiersma, JE, van Oppen, P, van Schaik, DJF, et al.Psychological characteristics of chronic depression: A longitudinal cohort study. J Clin Psychiatry 2011; 72: 288–294CrossRefGoogle ScholarPubMed
Zimmerman, M, McGlinchey, JB, Posternak, MA, et al. Remission in depressed outpatients: More than just symptom resolution? J Psychiatr Res 2008; 42: 797–801CrossRefGoogle ScholarPubMed