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Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views

Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views
Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views
Background: as a response to evidence that mental health service users and carers expect greater involvement in decisions about antipsychotic medication choice and prescribing, shared decision-making (SDM) has increasingly come to be viewed as an essential element of person-centred care and practice. However, this aspiration has yet to be realised in practice, as service users and carers continue to feel alienated from healthcare services. Existing understanding of the factors affecting the use of tools to support SDM is limited to inter-individual influences and wider factors affecting potential implementation are underexplored.

Aim: to explore the potential use of a tool designed to enhance collaborative antipsychotic prescribing from the perspectives of secondary care mental health service users, carers and professionals.

Methods: we conducted a qualitative study (semi-structured interviews and focus groups) using a convenience sample of 33 participants (10 mental health service users, 10 carers and 13 professionals) involved in antipsychotic prescribing in one Trust in the North of England. Participants were asked about the potential implementation of a tool to support SDM within secondary mental health services. Framework analysis incorporating the use of constant comparative method was used to analyse the data.

Results: the study identified a divergence in the views of service users and professionals, including a previously undocumented tendency for stakeholder groups to blame each other for potential implementation failure. This dissonance was shaped by meso and macro level influences relating to paternalism, legislative frameworks, accountability and lack of resources. Participants did not identify any macro level (policy or structural) facilitators to the use of the tool highlighting the negative impact of mental health contexts. Our study indicated that inter-individual factors are likely to be most important to implementation, given their potential to transcend meso and macro level barriers.

Conclusions: consideration of the meso and macro level influences identified areas for potential intervention, including challenging professionals’ and service users’ perceptions of each other, rebalancing the notion of accountability within services and introducing new means for service user feedback on the quality of SDM. Multi-level strategies for facilitating the implementation of tools to support SDM are also presented.
Brooks, Helen
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Harris, Kamelia
92eeb10a-8cf6-439a-bbd1-559cac19637a
Bee, Penny
76e373ee-12be-4966-8bb6-8157e1dc037d
Lovell, Karina
5d35b37c-4545-4ba4-a66c-9d94e1e9e780
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Drake, Richard
a031e7ce-cc6d-489d-939f-2f8faad32d43
Brooks, Helen
0056a0c8-f97a-4215-99e1-652291fcd6eb
Harris, Kamelia
92eeb10a-8cf6-439a-bbd1-559cac19637a
Bee, Penny
76e373ee-12be-4966-8bb6-8157e1dc037d
Lovell, Karina
5d35b37c-4545-4ba4-a66c-9d94e1e9e780
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Drake, Richard
a031e7ce-cc6d-489d-939f-2f8faad32d43

Brooks, Helen, Harris, Kamelia, Bee, Penny, Lovell, Karina, Rogers, Anne and Drake, Richard (2017) Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views. International Journal of Mental Health Systems. (doi:10.1186/s13033-017-0149-z).

Record type: Article

Abstract

Background: as a response to evidence that mental health service users and carers expect greater involvement in decisions about antipsychotic medication choice and prescribing, shared decision-making (SDM) has increasingly come to be viewed as an essential element of person-centred care and practice. However, this aspiration has yet to be realised in practice, as service users and carers continue to feel alienated from healthcare services. Existing understanding of the factors affecting the use of tools to support SDM is limited to inter-individual influences and wider factors affecting potential implementation are underexplored.

Aim: to explore the potential use of a tool designed to enhance collaborative antipsychotic prescribing from the perspectives of secondary care mental health service users, carers and professionals.

Methods: we conducted a qualitative study (semi-structured interviews and focus groups) using a convenience sample of 33 participants (10 mental health service users, 10 carers and 13 professionals) involved in antipsychotic prescribing in one Trust in the North of England. Participants were asked about the potential implementation of a tool to support SDM within secondary mental health services. Framework analysis incorporating the use of constant comparative method was used to analyse the data.

Results: the study identified a divergence in the views of service users and professionals, including a previously undocumented tendency for stakeholder groups to blame each other for potential implementation failure. This dissonance was shaped by meso and macro level influences relating to paternalism, legislative frameworks, accountability and lack of resources. Participants did not identify any macro level (policy or structural) facilitators to the use of the tool highlighting the negative impact of mental health contexts. Our study indicated that inter-individual factors are likely to be most important to implementation, given their potential to transcend meso and macro level barriers.

Conclusions: consideration of the meso and macro level influences identified areas for potential intervention, including challenging professionals’ and service users’ perceptions of each other, rebalancing the notion of accountability within services and introducing new means for service user feedback on the quality of SDM. Multi-level strategies for facilitating the implementation of tools to support SDM are also presented.

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Accepted/In Press date: 12 June 2017
e-pub ahead of print date: 28 June 2017

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Local EPrints ID: 412093
URI: https://eprints.soton.ac.uk/id/eprint/412093
PURE UUID: 86354f82-7785-4669-833c-d1d8d5e052fa

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Date deposited: 07 Jul 2017 16:31
Last modified: 14 Aug 2019 17:26

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