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Articles   |    
Factors Associated With Shared Decision–Making Preferences Among Veterans With Serious Mental Illness
Stephanie G. Park, Ph.D.; Marisa Derman, M.D.; Lisa B. Dixon, M.D., M.P.H.; Clayton H. Brown, Ph.D.; Elizabeth A. Klingaman, Ph.D.; Li Juan Fang, M.S.; Deborah R. Medoff, Ph.D.; Julie Kreyenbuhl, Pharm.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201400131
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Dr. Park, Dr. Brown, Dr. Klingaman, Dr. Medoff, and Dr. Kreyenbuhl are with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Capitol Health Care Network (VISN 5), Baltimore (e-mail: stephanie.park5@va.gov). Dr. Brown is also with the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Dr. Medoff and Dr. Kreyenbuhl are also with the Department of Psychiatry, University of Maryland School of Medicine, where Ms. Fang is affiliated. Dr. Derman and Dr. Dixon are with the New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study evaluated preferences for shared decision making with respect to mental health treatment in a sample of veterans who were diagnosed as having serious mental illness.

Methods  Participants were 239 outpatients receiving care from the Department of Veterans Affairs who completed self-report questionnaires assessing demographic factors, shared decision–making preferences, psychiatric symptom severity, and the therapeutic relationship with their second-generation antipsychotic prescribers (N=21). Preferences were assessed in regard to three components of decision making: knowledge about mental illness, options about mental health treatment, and decisions about mental health care.

Results  Most participants (85%) indicated that they preferred to be offered options and to be asked their opinions about mental health treatment. More variability was noted in preferences for obtaining knowledge and making final treatment decisions; 61% preferred to rely on their providers’ knowledge and 64% preferred their provider to make treatment final decisions. Greater preferences for participation in shared decision making were found among African American clients, those currently working for pay, those with college or higher education, those with other than a schizophrenia spectrum diagnosis, and those who reported a poorer therapeutic relationship with their prescribers.

Conclusions  The degree to which veterans with serious mental illness desired to participate in their mental health care differed in terms of the aspect of care and across demographic and clinical factors. A thorough assessment of shared decision–making preferences is an important component of recovery-oriented, client-centered care.

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Figure 1 Preferences for shared decision making for mental health care among 239 veteransa

a Assessed in regard to three components of care: options about treatment, knowledge about mental illness, and decisions about care. For the options question, higher ratings indicate stronger preferences for being offered choices and sharing one's opinion about treatments for mental illness. For the knowledge and decision questions, the higher the rating, the stronger the preference to rely on oneself rather than on one's provider for obtaining information and for making decisions, respectively. Options, median=6; knowledge, median=3; decision, median=3

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Table 1Analysis of variables as predictors of preferences regarding participation in shared decision making among 239 veterans
Table Footer Note

a Overall model F=4.69, df=13 and 222, R2=.22, p<.001

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c Overall model F=2.62, df=13 and 222, R2=.13, p=.002

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d Revised Behavior and Symptom Identification Scale

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e Scale To Assess the Therapeutic Relationship

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