The Meaning of Shared Decision-Making in Mental Care – A Hermeneutical Study

Abstract

Background: Shared decision-making is understood to be a process where the patients and the mental healthcare professionals are engaged in a dialogue of information in order to understand each other’s preferences and values regarding care and to agree on a plan of action. This understanding is mainly derived from a medical context. It is important that the scientific knowledge of shared decision-making is linked to the practice where it is to be carried out. The understanding of shared decision-making and its meaning in mental care needs to be developed, based on a caring science perspective. Aims: The overall aim of this study was to develop a deeper understanding of the meaning of shared decision-making in mental care. The specific aims of the three sub-studies were: I) To describe patient participation in shared decision-making in the context of indoor mental care. II) To explore how mental healthcare professionals describe shared decision-making in a therapeutic milieu as expressed through clinical supervision. III) To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. Methods: This thesis has a hermeneutical approach with an explorative design. Data were collected by means of three empirical sub-studies (Papers I, II and III), which contain in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Data analysis methods include qualitative content analysis (Papers I and II) and thematic interpretive analysis (Paper III). A deeper understanding of the meaning of shared decision-making was developed based on the empirical inductive findings, through deductive interpretation and finally an abductive interpretation. Findings: The first sub-study revealed the main theme thriving in relation to participating actively in a complementary ensemble of care, and the two themes having mental space to discover my way forward and being in a position to express my case. In the second sub-study, the theme was practising shared decision-making when balancing between power and responsibility to form safe care, comprising the three categories internalizing the mental healthcare professionals’ attributes, facilitating patient participation and creating a culture of trust. The third sub-study revealed the overall theme being in a space of sharing decision-making for dignified mental care, comprising the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. The three sub-studies represented parts of a larger whole of the investigated phenomenon and a synthesis of them was developed. Through a deductive interpretation two understandings emerged; Shared decision- making - a healing process and an integral part of mental care as well as Shared decision-making - a process of understanding. The final abductive stage illuminated the comprehensive understanding: The meaning of shared decision-making in mental care is being partners with an existential responsibility. Conclusion: The meaning of shared decision-making in mental care is being partners with an existential responsibility. The relationship between a person in need of care and the carer constitutes the existential responsibility, which acknowledges the being in human beings and is essential for mental growth. The mental healthcare professionals should be the patients’ partner and supporter throughout care. This understanding conveys that shared decision-making requires great attention to emotional and relational qualities, scoping the existential dimensions in mental care.