title: Factors associated with shared decision-making preferences among veterans with serious mental illness.
abstract: OBJECTIVE
  This study evaluated preferences for shared decision making with respect to mental health treatment in a sample of veterans who were diagnosed as having serious mental illness.
  
  
  METHODS
  Participants were 239 outpatients receiving care from the Department of Veterans Affairs who completed self-report questionnaires assessing demographic factors, shared decision-making preferences, psychiatric symptom severity, and the therapeutic relationship with their second-generation antipsychotic prescribers (N=21). Preferences were assessed in regard to three components of decision making: knowledge about mental illness, options about mental health treatment, and decisions about mental health care.
  
  
  RESULTS
  Most participants (85%) indicated that they preferred to be offered options and to be asked their opinions about mental health treatment. More variability was noted in preferences for obtaining knowledge and making final treatment decisions; 61% preferred to rely on their providers' knowledge and 64% preferred their provider to make treatment final decisions. Greater preferences for participation in shared decision making were found among African American clients, those currently working for pay, those with college or higher education, those with other than a schizophrenia spectrum diagnosis, and those who reported a poorer therapeutic relationship with their prescribers.
  
  
  CONCLUSIONS
  The degree to which veterans with serious mental illness desired to participate in their mental health care differed in terms of the aspect of care and across demographic and clinical factors. A thorough assessment of shared decision-making preferences is an important component of recovery-oriented, client-centered care.
authors.affiliation: Dr. Park, Dr. Brown, Dr. Klingaman, Dr. Medoff, and Dr. Kreyenbuhl are with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Capitol Health Care Network (VISN 5), Baltimore (e-mail: stephanie.park3@va.gov ). Dr. Brown is also with the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Dr. Medoff and Dr. Kreyenbuhl are also with the Department of Psychiatry, University of Maryland School of Medicine, where Ms. Fang is affiliated. Dr. Derman and Dr. Dixon are with the New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Park
authors.forename: Marisa
authors.initials: M
authors.lastname: Derman
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Dixon
authors.forename: Clayton H
authors.initials: CH
authors.lastname: Brown
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Klingaman
authors.forename: Li Juan
authors.initials: LJ
authors.lastname: Fang
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Medoff
authors.forename: Julie
authors.initials: J
authors.lastname: Kreyenbuhl
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008605:Mental Health Services; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health