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August 18, 2021

Time to Support Extensive Implementation of Shared Decision Making in Psychiatry

Author Affiliations
  • 1Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
  • 2Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
  • 3Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 4New Hampshire Hospital, Concord, New Hampshire
JAMA Psychiatry. 2021;78(11):1183-1184. doi:10.1001/jamapsychiatry.2021.2247

Shared decision making (SDM) is a health communication approach focusing on patient-clinician interactions around treatment decisions, with the goals of improving clinical and functional outcomes and providing personalized care.1 The fundamental principles of SDM involve (1) eliminating power asymmetries between clinician and patient; (2) acknowledging that there are at least 2 expert participants: a patient having lived-experience expertise, a clinician having professional expertise, and sometimes a family member2; (3) eliciting patient preferences for their involvement in the decision-making (autonomously, conjointly with clinician input, letting clinician make decisions) and eliciting the patient’s specific values that could guide the decision (eg, reducing medication adverse effects); (4) discussing at least 2 treatment options (eg, taking, tapering, or stopping antipsychotic medications); (5) making a decision that aligns with the patient’s goals, preferences, and values that also makes clear the risks involved in particular decisions3; and (6) accepting that the patient’s choice of treatment plan may differ from the clinician’s recommendation. SDM has been endorsed as the gold standard of patient-clinician interaction in preference-based care by the National Academy of Medicine in the US and the National Institute for Health and Care Excellence in the UK. Studies in the last decade of individuals with serious mental illness (SMI) demonstrating the feasibility of using SDM, and showing the potential for improved outcomes, support the recent acknowledgment of SDM as an essential practice by the American Psychiatric Association4 and the Substance Abuse and Mental Health Services Administration.

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