Implementing shared decision-making for hospitalized patients with schizophrenia: a qualitative study of nurse and patient perspectives.

BACKGROUND

Shared decision-making (SDM) is fundamental to person-centered psychiatry, yet its implementation in schizophrenia care remains limited and poorly understood. Existing research predominantly examines SDM from either healthcare provider or patient perspectives, overlooking the integrated perspectives from both sides within clinical settings.

OBJECTIVE

To explore shared decision-making experiences in inpatient schizophrenia care from the integrated perspectives of nurses and patients on the same clinical unit.

METHODS

A phenomenological qualitative study was conducted in a tertiary psychiatric hospital in Jiangsu Province, China. Semi-structured interviews were conducted with 12 psychiatric nurses and 12 inpatients with schizophrenia between April and December 2024. Data were analyzed using Colaizzi's seven-step phenomenological analysis framework.

RESULTS

Both nurses and patients recognized the value of SDM, yet implementation encountered multidimensional barriers. Four interconnected themes emerged (1): Perceptions of SDM and role positioning-nurses recognized the value of SDM and assumed multiple facilitator roles, while patients' perceived capacity for participation fluctuated with clinical status, requiring dynamic assessment and progressive engagement; (2) Attitudes and trust relationships influencing SDM implementation-nurses displayed diverse attitudes ranging from proactive support to explicit opposition, while trust between clinicians and patients was identified as the cornerstone of effective SDM; (3) Practical challenges in SDM implementation-clinical and ethical complexities, compounded by ineffective information communication, created significant barriers to SDM; and (4) Internal and external support systems affecting SDM-family involvement exerted dual influences of facilitation and paternalistic substitution, while pervasive social stigma further hindered patient participation.

CONCLUSIONS

Implementing SDM in schizophrenia care is a systematic endeavor shaped by the interplay of conceptual, relational, communicative, and contextual factors. Advancing patient-centered psychiatry requires a dual transformation: empowering nurses as skilled facilitators while actively activating patients as central participants, supported by trust-based relationships, tailored information tools, and integrated family-social resources.