Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations

Caroline Gurtner, Christa Lohrmann, Jos M. G. A. Schols and Sabine Hahn
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Caroline Gurtner: Applied Research and Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland
Christa Lohrmann: Institute of Nursing Science, Medical University Graz, 8010 Graz, Austria
Jos M. G. A. Schols: Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
Sabine Hahn: Applied Research and Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland

IJERPH, 2022, vol. 19, issue 6, 1-16

Abstract: Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals’ communication style as well as the patients’ personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended.

Keywords: shared decision making; clinical practice; psychiatric inpatient setting; interprofessional psychiatric consultations; psychiatric disorder; mental illness; communication; patient involvement; patient-centered care; participant observation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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