The rationale for shared decision making in mental health care: a systematic review of academic discourse

Date11 September 2017
Publication Date11 September 2017
AuthorKaren James,Alan Quirk
SubjectHealth & social care,Mental health
The rationale for shared decision making
in mental health care: a systematic
review of academic discourse
Karen James and Alan Quirk
Purpose The purpose of this paper is to i dentify and describe, in a systemati c way, the various academic
discourses on the rationale for shared decision making (SDM) in mental health care, and so provide
a comprehensive account of the ways in which this emerging field is being conceptualised in the
research literature .
Design/methodology/approach This study is a systematic review of peer-reviewed papers presenting a
rationale for SDM in mental health. Relevant databases were searched from inception to July 2016.
Data were analysed using a thematic analysis which aimed to identify and describe different discourses on
the rationale for SDM in mental health care. Data were extracted into a standardised data extraction
form which contained fields representing the developing thematic framework, study information and
research methodology.
Findings An initial search returned returned 1,616 papers, of which 175 were eligible for inclusion in this
review. The authors developed ten distinct but interrelated themes which capture the various academic
discourses on the rationale for SDM and represent some compelling arguments for SDM from a range of
different perspectives including ethical, clinical, userfocussed, economic and political. Dominant narratives
in the literature linked SDM to the recovery moment and person-centred care, and adherence and
engagement with mental health services.
Research limitations/implications The authorsare unable to make any conclusionsabout the strength of
evidence for theserationales. The review was restrictedto peer-reviewed publications,published in English.
Practical implications The findings could be a useful framework to support the selection of outcome
measures for SDM evaluations.
Originality/value There have been no systematic reviews published in this area previously.
Keywords Mental health, Systematic review, Shared decision making
Paper type General review
1. Introduction
Shared decision making (SDM) is a process through which a person accessing health services
and the clinician supporting them reach an agreed decision about the direction of care
(Charles et al., 1997). It is a collaborative process which places equal value on the practitioners
scientific and clinical knowledge, and the personal experiences, goals and preferences of the
individual (experiential knowledge). It is thought to be well established within general health
services and there has been a large body of research reporting some evidence for the benefits of
SDM within these settings, including reduced decisional conflict, and, amongst people
accessing services, increased knowledge, satisfaction with care, participation in decision making
and improved clinical outcomes (Austin et al., 2015; Durand et al., 2014; Joosten et al., 2008).
Some have argued that SDM is particularly valuable when supporting someone who is
experiencing chronichealth problems because, in these cases, decisions about care are
likely to be made, revisited and revised on many occasions over a long period of time
(McMullen, 2012). SDM is also thought to address issues of paternalism and inequity of
power within the therapeutic relationship, and so could support the implementation of
Received 18 January 2017
Revised 4 May 2017
Accepted 26 May 2017
Karen James is a Postdoctoral
Researcher at the Faculty of
Health Social Care and
Education, a joint initiative of
St George's University of
London and Kingston
University, London, UK.
Alan Quirk is a Senior
Programme Manager (Audits &
Research) at the Royal College
of Psychiatrists, London, UK.
VOL. 22 NO. 3 2017, pp. 152-165, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-01-2017-0009

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