Factors influencing patients’ preferences and perceived involvement in shared decision-making in mental health care

Abstract

Background: Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients’ expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation.

Aims: To investigate patients’ preferences and appraisals of their involvement in treatment decisions.

Methods: Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis.

Results: Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient–provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse.

Conclusion: Patients’ preferences and willingness to engage in shared decision-making fluctuate over time and are context dependent. A better understanding of these factors and a strong patient–provider relationship will facilitate better measurement and implementation of shared decision-making.

• Mental health
• patient’s preferences and participation
• shared decision-making
• veterans

Acknowledgements

We wish to thank Linda Collins, Jessica Coffing, Ruth Firmin, Erin Adams, and Erica Evans for their assistance with data collection.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. The project reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (CDA 10-034), Center for Health Information and Communication, CIN 13-416, and the VA Health Services Research & Development Fellowship. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.