title: Shared decision-making in mental health care-A user perspective on decisional needs in community-based services.
abstract: BACKGROUND
  Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice.
  
  
  OBJECTIVE
  The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden.
  
  
  METHODS
  Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM.
  
  
  RESULTS
  The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process.
  
  
  CONCLUSIONS
  The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.
authors.affiliation: School of Health and Social Work, Dalarna University, Falun, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Grim
authors.affiliation: Department of Social Work, Umeå University, Umeå, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Rosenberg
authors.affiliation: School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
authors.forename: Petra
authors.initials: P
authors.lastname: Svedberg
authors.affiliation: School of Health and Social Work, Dalarna University, Falun, Sweden; uks@du.se.
authors.forename: Ulla-Karin
authors.initials: UK
authors.lastname: Schön
mesh_terms: D000328:Adult; D003071:Cognition; D003142:Communication; D003156:Community Mental Health Services; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008960:Models, Psychological; D010358:Patient Participation; D011209:Power, Psychological; D011369:Professional-Patient Relations; D013548:Sweden; D055815:Young Adult
keywords: Shared decision-making; directed content analysis; information needs; mental health care