title: Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship.
abstract: OBJECTIVE
  Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction.
  
  
  METHODS
  Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction.
  
  
  RESULTS
  Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction.
  
  
  CONCLUSIONS
  When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship.
authors: Mental Illness Research, Education, and Clinical Center, VA Capitol Health Care Network (VISN 5).
authors: Elizabeth A
authors: EA
authors: Klingaman
authors: Department of Psychiatry, University of Maryland School of Medicine.
authors: Deborah R
authors: DR
authors: Medoff
authors: Department of Psychology, University of Maryland.
authors: Stephanie G
authors: SG
authors: Park
authors: VA Capitol Health Care Network (VISN 5).
authors: Clayton H
authors: CH
authors: Brown
authors: Department of Psychiatry, University of Maryland School of Medicine.
authors: Lijuan
authors: L
authors: Fang
authors: New York State Psychiatric Institute.
authors: Lisa B
authors: LB
authors: Dixon
authors: VA Capitol Health Care Network (VISN 5).
authors: Samantha M
authors: SM
authors: Hack
authors: Department of Health Policy and Management, Emory University.
authors: Stephanie L
authors: SL
authors: Tapscott
authors: VA Capitol Health Care Network (VISN 5).
authors: Mary Brighid
authors: MB
authors: Walsh
authors: Capitol Health Care Network (VISN 5).
authors: Julie A
authors: JA
authors: Kreyenbuhl
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D016032:Randomized Controlled Trials as Topic; D014728:Veterans