Shared Decision Making in pharmacotherapy with patients with severe mental health disorders - Extern promotieonderzoek

Shared Decision Making (SDM) has become the standard in modern doctor-patient
communication. SDM can be defined as an interactive process between patient and health
care provider where information and opinions are shared, provider responsibilities and
patient preferences and values are discussed and at the end a decision is made that, ideally,
both parties agree on.

The need for wider implementation across the field of medicine is advocated. Many benefits
of SDM are described, such as increased involvement and reduced stigma, and also
improved adherence and patient satisfaction.
Still, previous studies have shown that SDM is not widely implemented in mental health
care.

There are many discipline-specific issues in daily practice, such as (episodic) cognitive
dysfunction and decision incapacity caused by the course of the illness, stigmatization, and
involuntary treatment. Moreover, the lack of one unambiguous method and too little
attention on SDM in psychiatry residency can also contribute to the difficulty of
implementation.

The goal of this PhD thesis is to gain insight in the specific character of SDM in severe mental
health care and contribute to better understanding and implementation. The thesis is
divided in two parts: part I includes several studies on SDM in patient populations from
severe mental health care. The second part presents a residents’ teaching course about SDM
in severe mental health.

Part I
This thesis will start with an overview of all typical aspects of SDM in severe mental health
care described in literature and we will address implementation barriers. In the second study
we’ll observe to what extend SDM is practiced in the consultation room between caregiver
and patients with a bipolar disorder and the preferences of these patients in the process of
decision making. In the third study, we will describe the wishes and opinions of patients with
a first psychotic episode on the decision process of deprescribing antipsychotic medication.

Part II
At present there is no communication model for SDM addressing specific aspect of mental
health care. In the first study of part II we will start with presenting a didactic model of SDM
in severe mental health we will develop. Furthermore, we will present a complete teaching
course, based on the didactic model, for psychiatry residents. In the second study of part II ,
we will present the evaluation of the effect of this training program.