Experiential and Medical Knowledge of Shared Decision-Making: Exploring Clinician and Service User Perspectives in NHS Community Mental Health Services.

BACKGROUND

A fundamental barrier to effective recovery outcomes for psychosis, is the lack of involvement of service users (SUs) in decisions made about their care. Despite policy recommendations, implementation of shared decision-making (SDM) is inconsistent, under-reported in mental health practice and thus requires further attention. This research aimed to explore SU and clinician experiences of SDM in community mental health care.

DESIGN

Qualitative data from a cross-sectional mixed-method study is presented. A purposive sample of 18 participants (10 SUs experiencing psychosis, 8 psychiatrists) from one NHS community mental health service, took part in semi-structured interviews which underwent reflexive thematic analysis.

RESULTS

Participants acknowledged SDM as integral to consultations, with overlaps and disparities in SU and clinician perceptions of the reality in practice. Three themes are reported: (1) knowledge and capacity for SDM, (2) relational dynamics; power and communication in SDM and (3) evaluating the realities of SDM in practice. SUs reported they needed to be in the right frame of mind while clinicians acknowledged they were struggling and it wasn't easy to take medication. SUs also wanted to be more engaged in decisions about their care, involving others in the process, with further clarification about options, and alluded to power asymmetry. Clinicians and SUs stressed that structural pressures (concerning time and resources) limited explanation of treatment options and clinicians reflected on stigma they faced. They questioned if SUs experienced the service they thought they were providing.

DISCUSSION: SU and clinician perceptions often overlapped but at times misaligned, suggesting inconsistency in practicing SDM. Implications for practitioners and policy makers include revisiting how SDM is used in practice, with adequate structural and resource provision, potentially involving others to bridge the gap between experiential and medical knowledge. Limitations are reflected on, however, this research emphasises the importance of consistent use of SDM in community mental health.

PATIENT OR PUBLIC CONTRIBUTION: Service users, academics, and clinicians from the Centre for Public Engagement, Kingston University participated in the research design, development of study materials and data analyses. The study would not be possible without this involvement.