title: Factors influencing patients' preferences and perceived involvement in shared decision-making in mental health care.
abstract: BACKGROUND
  Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients' expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation.
  
  
  OBJECTIVE
  To investigate patients' preferences and appraisals of their involvement in treatment decisions.
  
  
  METHODS
  Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis.
  
  
  RESULTS
  Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient-provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse.
  
  
  CONCLUSIONS
  Patients' preferences and willingness to engage in shared decision-making fluctuate over time and are context dependent. A better understanding of these factors and a strong patient-provider relationship will facilitate better measurement and implementation of shared decision-making.
authors.affiliation: Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush VA Medical Center , Indianapolis, IN , USA .
authors.forename: Johanne
authors.initials: J
authors.lastname: Eliacin
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Salyers
authors.forename: Marina
authors.initials: M
authors.lastname: Kukla
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D014728:Veterans / Q000523:psychology; D055815:Young Adult
keywords: Mental health; patient’s preferences and participation; shared decision-making; veterans