title: Consumer and relationship factors associated with shared decision making in mental health consultations.
abstract: OBJECTIVE
  This study explored the association between shared decision making and consumers' illness management skills and consumer-provider relationships.
  
  
  METHODS
  Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures.
  
  
  RESULTS
  Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships.
  
  
  CONCLUSIONS
  Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.
authors.affiliation: Dr. Matthias, Dr. Kukla, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana (e-mail: mmatthia@iupui.edu ). Dr. Matthias is also with the Regenstrief Institute, Indianapolis. Dr. Kukla is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, where Ms. Bonfils, Ms. Firmin, Ms. Oles, Ms. Adams, and Dr. Salyers are also affiliated. Dr. Fukui is with the Department of Social Welfare, University of Kansas, Lawrence.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.forename: Sadaaki
authors.initials: S
authors.lastname: Fukui
authors.forename: Marina
authors.initials: M
authors.lastname: Kukla
authors.forename: Johanne
authors.initials: J
authors.lastname: Eliacin
authors.forename: Kelsey A
authors.initials: KA
authors.lastname: Bonfils
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Firmin
authors.forename: Sylwia K
authors.initials: SK
authors.lastname: Oles
authors.forename: Erin L
authors.initials: EL
authors.lastname: Adams
authors.forename: Linda A
authors.initials: LA
authors.lastname: Collins
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Salyers
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D054539:Medication Therapy Management; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D014728:Veterans / Q000523:psychology; D016903:Drug Monitoring