Journal Article

Exploring patterns in psychiatric outpatients’ preferences for involvement in decision-making: a latent class analysis approach

Mundal, Ingunn, De las Cuevas, Carlos, Lara-Cabrera, Mariela Loreto, Betancort, Moisés

2021

Overview

Background Shared decision-making (SDM), a collaborative approach that includes and respects patients’ preferences for involvement in decision-making about their treatment, is increasingly advocated. However, in the practice of clinical psychiatry, implementing SDM seems difficult to accomplish. Although the number of studies related to psychiatric patients’ preferences for involvement is increasing, studies have largely focused on understanding patients in public mental healthcare settings. Thus, investigating patient preferences for involvement in both public and private settings is of particular importance in psychiatric research. The objectives of this study were to identify different latent class typologies of patient preferences for involvement in the decision-making process, and to investigate how patient characteristics predict these typologies in mental healthcare settings. Methods We conducted latent class analysis (LCA) to identify groups of psychiatric outpatients with similar preferences for involvement in decision-making to estimate the probability that each patient belonged to a certain class based on sociodemographic, clinical and health belief variables. Results The LCA included 224 consecutive psychiatric outpatients’ preferences for involvement in treatment decisions in public and private psychiatric settings. The LCA identified three distinct preference typologies, two collaborative and one passive, accounting for 78% of the variance. Class 1 (26%) included collaborative men aged 34–44 years with an average level of education who were treated by public services for a depressive disorder, had high psychological reactance, believed they controlled their disease and had a pharmacophobic attitude. Class 2 (29%) included collaborative women younger than 33 years with an average level of education, who were treated by public services for an anxiety disorder, had low psychological reactance or health control belief and had an unconcerned attitude toward medication. Class 3 (45%) included passive women older than 55 years with lower education levels who had a depressive disorder, had low psychological reactance, attributed the control of their disease to their psychiatrists and had a pharmacophilic attitude. Conclusions Our findings highlight how psychiatric patients vary in pattern of preferences for treatment involvement regarding demographic variables and health status, providing insight into understanding the pattern of preferences and comprising a significant advance in mental healthcare research.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Anxiety disorders / Attitudes / Behavior / Beliefs, opinions and attitudes / Collaboration / Community mental health services / Decision Making / Decision Making, Shared / Female / Health care policy / Humans / Informed consent / Latent Class Analysis / Male / Medicine / Medicine & Public Health / Mental disorders / Mental Disorders - therapy / Mental health / Mental health care / Outpatients / Patient Participation / Patient satisfaction / Patients / Physician-Patient Relations / Preferences / Private mental health service / Psychiatric patients / Psychiatry / Psychological aspects / Psychotherapy / Questionnaires / Research Article / Shared decision making / Social psychiatry / therapy and provision of mental health care