Finding Common Ground: Exploring the Experiences of Client Involvement in Medication Decisions Using a Shared Decision Making Model

Abstract

While shared decision making has gained more prominence in recent years in the field of general health care, few shared decision making models have been studied in the field of mental health. This constructivist study explores the experiences of twelve persons diagnosed with schizophrenia or other major thought disorder, along with their treatment providers (prescribers, nurses, case managers, and peer support workers), when introduced to a shared decision making model around psychiatric medications. Purposeful sampling, with an emphasis on achieving maximum variation, was used to better understand the interactive processes that contribute to as well as hinder client involvement in shared decision making. Multiple interviews with all participants over a one year period allowed for meaning making to unfold over time. Simultaneous involvement with data collection and data analysis was part of an emergent design that culminated in tentative constructions based on participant's experiences. Findings were subjected to a comprehensive member check for confirmability. Findings explore the multiple interacting factors that contribute to client's involvement in shared decision making, including agreement on a goal that is meaningful and important to the client to guide decisions, the relationship between the prescriber and the client, the presence of non-pharmaceutical alternatives that expand decision options, and behaviors by auxiliary supports (i.e. case management and peer support) that facilitate involvement. Findings also explore the complexity of thought behind client's decisions to use psychiatric medications and the dynamics that change when a new model of decision making is introduced. The findings became the basis of proposing a new tentative framework for shared decision making as well as a concept called activation points. While the findings are intended to improve the process at a specific mental health center, readers are invited to join the dialogue in regards to the transferability of the findings to other settings.