title: Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts.
abstract: Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).
authors.affiliation: a School of Communication & Information , Rutgers University.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mikesell
authors.affiliation: b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles.|c Desert Pacific VA Mental Illness Research , Education and Clinical Center (MIRECC), West Los Angeles VA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bromley
authors.affiliation: b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles.|c Desert Pacific VA Mental Illness Research , Education and Clinical Center (MIRECC), West Los Angeles VA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
authors.affiliation: b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles.
authors.forename: Pamela
authors.initials: P
authors.lastname: Vona
authors.affiliation: b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Zima
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D005190:Family; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008605:Mental Health Services; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D010551:Personality; D010817:Physician-Patient Relations; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
chemical_list: D014150:Antipsychotic Agents