PSYCHIATRIC PATIENTS' ATTITUDES TOWARDS SHARED DECISION MAKING

Purpose:    To assess psychiatric outpatients’ attitudes towards shared decision making in an outpatient psychiatric setting and how socio-demographic and clinical variables influence their preferences.

Method:    A total of 435 consecutive psychiatric outpatients attended in Community Mental Health Centres of the Canary Islands Health Service expressed along first trimester of 2010 preferences ranging from patient-directed to physician-directed styles on each of three aspects of decision making (seeking information, discussing options, making the final decision). A lineal regression analysis was made to assess relationships between sociodemographic variables (gender, age and education) and the expressed preferences.

Result:    The 435 patients who agreed to participate in the study had a mean age of 42.8±11.8 years (range, 18–84) and 65% were female. Concerning educational level the 9.7% had no formal education, 44.8% had completed primary studies, 31.5% had completed secondary studies and 14% had a university degree.    For the 328 patients with data about current medications, the mean number of psychotropic drugs used was 2.7±1.2 (range 0–6). The 18.8% of the patients were under monotherapy treatment, whereas 26.2% received two drugs, 32.9% received three, and 21.8% received four or more drugs.    Concerning the psychiatric patients’ preferences for participation in decision making, the great majority of patients (90.4%) preferred to be offered choices and to be asked their opinions. In contrast, 76.1% preferred to leave final decisions to their psychiatrists and 73.9% preferred to rely on physicians for medical knowledge rather than seeking out information themselves. Older patients tended to prefer rely on physicians’ knowledge, while being women was associated to the preference of being offered choices. No significant predictors of preference to leave final decisions to psychiatrists were obtained.

Conclusion:    Psychiatric outpatients vary substantially in their preferences for participation in decision making process. Psychiatrists should not assume that patients wish to participate in clinical decision making, but must assess individual patient preferences and tailor care accordingly. Age and gender significantly predicts different aspects of preference for shared decision making.