Content and implementation of clinical decisions in the routine care  of people with severe mental illness.
BACKGROUND
Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains.


OBJECTIVE
To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content.


METHODS
As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented.


RESULTS
Agreement between patients and staff regarding decision making was moderate (k = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content.


CONCLUSIONS
A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.
Jana
J
Konrad
Sabine
S
Loos
Petra
P
Neumann
Nadja
N
Zentner
Benjamin
B
Mayer
Mike
M
Slade
Harriet
H
Jordan
Corrado
C
De Rosa
Valeria
V
Del Vecchio
Anikó
A
Égerházi
Marietta
M
Nagy
Malene Krogsgaard
MK
Bording
Helle Østermark
HØ
Sørensen
Wolfram
W
Kawohl
Wulf
W
Rössler
Bernd
B
Puschner
D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D010817:Physician-Patient Relations