Shared decision making within the context of recovery-oriented care

Published date11 September 2017
Date11 September 2017
AuthorLarry Davidson,Janis Tondora,Anthony J. Pavlo,Victoria Stanhope
Subject MatterHealth & social care,Mental health
Shared decision making within the context
of recovery-oriented care
Larry Davidson, Janis Tondora, Anthony J. Pavlo and Victoria Stanhope
Purpose The purpose of this paper is to consider the role of shared decision making (SDM) as one
component of recovery-oriented care.
Design/methodology/approach This paper is conceptual and reviews the literature relevant to recovery-
oriented care, person-centered recovery planning (PCRP), and SDM.
Findings To the degree to which SDM offers tools for sharing useful information about treatment options
with service users and family members or other loved ones, it can be considered a valuable addition to the
recovery-oriented armamentarium. It is important to emphasize, though, that recovery-oriented practice has
a broader focus on the persons overall life in the community and is not limited to formal treatments or other
professionally delivered interventions. Within the more holistic context of recovery, SDM regarding such
interventions is only one tool among many, which needs to be integrated within an overall PCRP process.
More emphasis is given within the recovery-oriented care to activating and equipping persons for exercising
self-care and for pursuing a life they have reason to value, and the nature of the relationships required to
promote such processes will be identified. In describing the nature of these relationships, it will become
evident that decision making is only one of many processes that need to be shared between persons in
recovery and those who accept responsibility for promoting and supporting that persons recovery.
Originality/value By viewing SDM within the context of recovery, this paper provides a framework that can
assist in the implementation of SDM in routine mental health care.
Keywords Mental health, Shared decision making, Recovery-oriented practice
Paper type General review
You know, Im a human being and I have a past and I have dreams and [] before having the
person-centered plan in place, whats your dreamwas never in my dialogue [] it wasnt there.
What was your dream or what would you hope to do, we wouldnt talk [] like that (Provider trained in
person-centered care).
A core componentof the recovery movement thathas been reshaping mental healthcare since the
early 1990s has been an emphasis on restoring the rightsand responsibilities of full citizenshipto
persons with serious mental illnesses (Davidson, 2016). Although the nature of this new form of
recoveryappears to vary somewhat across cultures (e.g. Davidson et al., 2013), within the
context of social democracies, at least, foremost among these rights has been the right to
self-determination, while foremostamong these responsibilitieshas been that of taking ownership
of ones own recovery. The notion of taking responsibility for ones recovery is not limited to the
work of recovery(Davidson and Strauss, 1992), which refers to the efforts the person makes to
build a life of meaning and purpose beyond the limits of the illness. It also includes taking
responsibility for directing ones own care, choosing from among available options those various
forms of services and/or supports the person will actively use as toolsin his or her recovery
(Davidson et al., 2009). In this way, recovery-oriented care strivesto enable the person to occupy
the driversseat(Tondora et al., 2009) both in his or her life and in his or her treatment,
rehabilitation, and recovery.
Within this context, it might seem obvious that the concept of shared decision making(SDM)
would be a welcome additionto the recovery-oriented practitioners toolkit. As othercontributions
Received 18 January 2017
Revised 2 March 2017
Accepted 5 April 2017
This project has received funding
from the European Unions
Horizon 2020 research and
innovation programme under the
Marie Skłodowska-Curie Grant
Agreement No. 690,954. This
project also was supported by
grant number K12HS023000 from
the Agency for Healthcare
Research and Quality. The content
is solely the responsibility of the
authors and does not necessarily
represent the official views of the
Agency for Healthcare Research
and Quality.
Larry Davidson is a Professor,
Janis Tondora is an Associate
Professor and Anthony J. Pavlo
is an Associate Research
Scientist, all at the Program for
Recovery and Community
Health, Yale University School
of Medicine, New Haven,
Connecticut, USA.
Victoria Stanhope is an
Associate Professor at
New York University,
New York, New York, USA.
DOI 10.1108/MHRJ-01-2017-0007 VOL. 22 NO. 3 2017, pp. 179-190, © Emerald Publishing Limited, ISSN 1361-9322
PAG E 1 7 9

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