Involved, inputting or informing: "Shared" decision making in adult mental health care
Involved, inputting or informing: "Shared" decision making in adult mental health care
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DOI：
10.1111/hex.12601
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发表时间：
2018-02-01
影响因子：
3.2
通讯作者：
Green, Debra
中科院分区：
文献类型：
--
作者：
Bradley, Eleanor;Green, Debra
严重精神疾病的诊断会影响到整个家庭。家庭非正式地提供大量护理，但与那些支持患有其他长期疾病的人相比，家庭承担护理负担的风险不成比例。共同决策（SDM）是一种与积极健康结果相关的卫生沟通伦理模式；然而，很少有研究来评估家庭被邀请参加SDM的常规程度，或者这在实践中是什么样的。目的：这项英国研究旨在更好地了解重度精神障碍患者的家庭照顾者目前是如何参与决策的，特别是关于治疗方案的决策，包括处方药物。目的是探索家庭成员希望参与处方药物决策的程度，确定专业人员如何以及何时让家庭参与这些决策，确定与家庭参与治疗决策相关的障碍和促进因素。参与者的开放式问题被发送给专业人员和家庭成员，以获得书面答复。对定性反应进行主题分析。结果主题包括参与的定义和参与规则。工作人员是家庭参与的看门人，这个过程并不民主。家庭和工作人员将实际的，而不是以恢复为导向的角色归咎于家庭，他们的当务之急是坚持的观念。结论工作人员应用SDM需要支持、培训和教育。交换信息的时间是至关重要的，但实际上很困难。协商后的团队，包括工作人员、服务用户、家庭、同事（如适用），具有指定的角色和责任，可以支持SDM。
BackgroundA diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice.ObjectiveThis UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were toExplore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment.ParticipantsOpen-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically.ResultsThemes included the definition of involvement and rules of engagement. Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence.ConclusionsStaff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM.