Choice and Shared Decision Making

Shared Decision Making’ describes the conversation between a healthcare professional and a patient/individual which leads to an agreement about which treatment/intervention will be used.

The first stage of shared decision making is the healthcare professional giving all the options available and talking through the benefits/drawbacks of these. They can also use the conversation to highlight which option might be best for the person based on their particular circumstances.

The patient/individual then shares information about their life and their experiences, including previous experiences of treatments/interventions with the healthcare professional. They may feel that certain things will not fit well with their life, and this could include the treatment/intervention seen as ‘best’ in the healthcare professional’s view

The conversation goes on to look for a mutual understanding between the healthcare professional and the person – that they understand each other’s point of view. A decision on which treatment/intervention should be used can then be made together.

Shared decision making is becoming more and more common, especially in physical healthcare services. It’s new to mental health services but is very likely to grow.

 

 

Real life experience

In the early days of navigating my way through the mental health system, I obeyed the doctor’s advice as if it had come from some kind of God. My understanding was that I had an illness and the professionals were the experts, they knew best. It seemed my best chance of getting through this hell was to do what they suggested.

This began as an endless drug experiment; ‘Pink ones first, then up the dose, then add another, then up that dose. Right that’s not working lets pick a blue one this time but take it at night’………… and so on. I felt powerless to challenge this, didn’t want to complain about the drowsiness, the dry mouth, the increased appetite. It seemed obvious to me that I was getting worse not better but still the doctor was the expert right, I had respect for this. The same pattern occurred with what support I received, with what therapy, with hospital admissions, when they were and how long; doctor made the decisions in my best interest.

With my understanding now, I look back and realise this was doomed to fail. The psychiatrists may have had more knowledge of the evidence based practise and of their medical model of mental illness, but they did not know me. I had the knowledge of what I had been through, the knowledge of my difficulties, the knowledge of my own strengths, the knowledge of my natural support networks, and the knowledge of my preferences. Without these bits of information how could decisions about what would help me, be made?

Shared decision making recognizes the expertise of the professional but equally the expertise an individual has in their own lives. It is not about the clinician presenting a list of options but both parties understanding the others’ perspective.  It is in the space between these two perspectives where the decision is made.

I know have a relationship with my doctor where she listens to and understands my point of view and no decision is made without considering that. I feel much more confident in following the treatment plan knowing that we have come to it together. Shared decision making has empowered me to take ownership and feel more involved in my care and through this I am able to move forwards towards a better quality of life.