TITLE:
Preferences for participation in shared decision making of psychiatric outpatients with affective disorders
AUTHORS:
Carlos De las Cuevas, Wenceslao Peñate
KEYWORDS:
Patients Preferences; Shared Decision Making; Psychiatric Outpatients; Affective Disorders
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.1,
January
3,
2014
ABSTRACT: Objective: To assess preferences for participation
in shared decision making in a representative sample of psychiatric outpatients
with affective disorders and to understand how clinical and socio-demographic variables
influence patients’ preferences for participation. Method: A cross-sectional
survey of 172 consecutive psychiatric outpatients with affective disorders
attending at Community Mental Health Care setting was carried out. Patients
expressed preferences on each of 3 aspects of decision making (seeking information,
discussing options, making the final decision). The “CGI Severity and
Improvement Scales” and the “Beck Depression Inventory” scale were used for severity
assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about
Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were
applied to all participants. Effects of variables considered on preferences
were assessed using proportional odds regression models. Results: We registered
a high response rate of 85%. Nearly all patients (91%) preferred to leave final
decisions to their treating psychiatrists and 87% preferred to rely on
psychiatrists for medical knowledge rather than seeking their own information.
In contrast, 81% of patients preferred to be offered options and to be asked
their opinion by their doctors. Gender, age, educational level, number of
psychotropics used and belief about psychiatric medication overuse were significant
predictors in decision making dimensions considered. Conclusion: Shared
decision making approach of patients with affective disorder must take into
consideration a more doctor-directed approach preferred by the patients in
which the desire to be offered options is not automatically linked with the
willingness of taking decisions or getting more knowledge.