Involving patients in decisions during psychiatric consultations

Background. Patient involvement in the decision making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry. Aims. To assess in a psychiatric outpatient context how psychiatrists involve their patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement. Method. Eighty transcripts from audiotaped first outpatient consultations, conducted by 16 psychiatrists, were rated with the OPTION scale. Inter-rater reliability indices were obtained for thirty randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested by t-test, ANOVA and Pearson’s correlation coefficient where appropriate. The distribution of scores within psychiatrists was assessed by intracluster correlation coefficients. Results. Interrater reliability and internal consistency of the OPTION in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts or minimal skill level. Conclusions. The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities paralleling previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research will have to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect their outcome.