Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

ABSTRACT

Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants’ broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step’s Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).

Acknowledgments

The authors gratefully acknowledge the clients and clinicians for sharing their experiences and insights, Dr. Penelope Knapp whose leadership made this study possible, and the editor, Teresa L. Thompson, and two anonymous reviewers for their valuable feedback.This study was supported by the National Institute of Mental Health (P30MH082760).

Notes

¹ Two respondents did not report their client/family member status on the survey: The total number of client/family participants was 22.

² Two participants declined to report their demographic information and are not included in the summary statistics. Tests of neurocognition and symptom severity were not collected so functional status may vary among client participants.

³ Coping efficacy was not discussed as a factor impacting information management strategies. This may have been so because focus-group questions did not explicitly ask about the role of “nonclinical” resources such as family and social support.