Shared decision-making in ongoing outpatient psychiatric treatment.

Abstract

OBJECTIVE: Research on patient involvement in decision-making in psychiatry has focused on first encounters. This study investigated what decisions are made, level of patient involvement and factors influencing patient involvement in ongoing outpatient visits. METHODS: 72 visits conducted by 20 psychiatrists were video recorded. Patients had a diagnosis of depression or schizophrenia. RESULTS: On average, there was one medication related and one other decision per visit. Some psychiatrists involved patients more in decisions, as did female psychiatrists. Involvement was lower when patients had more negative symptoms. CONCLUSION: Involvement in decision-making appears to be influenced by the individual psychiatrist and specific symptoms but not visit length. PRACTICE IMPLICATIONS: It is noteworthy that patient involvement is not influenced by length of the visit given that this would be a barrier in busy clinical practice. The next step would be to identify the communication patterns of psychiatrists who involve patients more in decision-making.