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Skills for involving patients in decisions
- Josephine M Stanton (24 January 2009)
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Josephine M Stanton, Psychiatrist Starship, Auckland Healthcare
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josephines{at}adhb.govt.nz Josephine M Stanton
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In the discussion of their paper on involving patients in decision making Goss et al [1] list the skills required for involvement of patients in decsion making. Information gathering, relationship building and information giving skills are generally addressed in training of psychiatrists. What are not often identified as important for psychiatrists are skills in bringing forward patient knowledge. By their very nature psychiatric illnesses can impair cognitive functioning. At the point of presentation to a psychiatrist patients often feel disempowered and overwhelmed. Both these factors can undermine the ease with which they can access their ideas and knowledge to contribute to a decision making process. Motivational Interviewing [2] and Brief Solution Focused Therapy [3] are well known therapeutic approaches, each with a particular focus, which bring patients’ thoughts and ideas into their conscious awareness as a resource. A number of other approaches, notably cognitive therapy approaches, also bring thoughts into conscious awareness but the focus is towards changing or managing thoughts rather than valuing them as a resource. Johnella Bird [4] has developed a more comprehensive therapeutic approach which employs careful use of language and reflection to bring forward people’s knowledge, values, resource and agency. Embedded in this approach are a range of microskills which can enhance psychiatric consultation. I have worked with a colleague to develop a website outlining how Bird’s ideas can be applied to mental health work. [5] Below is a brief, one sided example of how some of these ideas can support patient involvement in decision making. When I suggested you take antipsychotic medication you responded quickly with a firm ‘no’. I would like to understand how you came to that decision. We are both aware that I hold the belief that antipsychotic medication could be helpful for you and you hold a different idea. In wanting to understand the decision you are making I am not seeking to persuade you. If the asking about the decision I am doing is feeling as if I am trying to persuade you I would like you to let me know. How can I support you to let me know? I am wondering if you would find it easier to use a hand signal than words. Would it help if I asked you, now and again, about the level of comfort you are feeling in the conversation? 1. Goss, C., et al., Involving patients in decisions during psychiatric consultations. British Journal of Psychiatry, 2008. 193: p. 416-421. 2. Miller, W.R. and S. Rollnick, Motivational Interviewing: Preparing People for Change. 2nd edition ed. 2002, New York London: Guilford Press. 3. O'Connell, Solution Focused Therapy. 1998, New York: Sage. 4. Bird, J., Talk that Sings: Therapy in a New Linguistic Key. 2004, Auckland: Edge Press. 5. Stanton, J. and T. Windelborn. www.collaborativepsychiatry.com. 2007 2008 [cited]. |
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