The intensity of decision making is multiplied for patients and their families when a disease that causes health problems, such as mental illnesses and life-threatening illnesses, are involved. Healthcare professionals are expected to participate in the decision-making process together with the patients and families to promote their interaction. Is "shared decision making" established currently in Japan? The practice of shared decision making is a fundamental problem in current medical care regardless of the disease that a patient has. "Patient-centered" has become a popular term; however, it may have been incorrectly interpreted, leaving decisions to be made entirely by the patients and their families. What is necessary to practice shared decision making in psychiatric care? I underwent psychiatric care when paternalism was the mainstream treatment approach. This study was conducted from the perspective of patients and their families based on my previous survey in which "clinical attitudes of psychiatrists" were evaluated by patients and families, together with my experience in hospices.
The tendency of having a pessimistic outlook because of professional experience should be corrected. To achieve this, an approach that I recommend is to learn about the patient's and family's lives, and acquire the habit of fact-based thinking. Other approaches include the following: shifting some tasks to other healthcare professionals, learning from practice in private civic groups, and training specialists who can provide medical consultation about life events such as pregnancy and childbirth.
The basic spirit of "shared decision making" is to hear from patients and families about their daily lives, and to imagine specific difficulties that they are experiencing while maintaining respect toward them. In both psychiatric care and overall medical care, we need to think about "shared decision making" from the perspective of "becoming a group" in the future.
Author's abstract
"Shared Decision Making" from the Perspective of Patients and their Families: Wisdom and Ingenuity for Mutual Understanding
Yakitsubenomichi Shinryojo
Psychiatria et Neurologia Japonica
123: 192-198, 2021
<Keywords:shared decision making, supported decision making, recovery, paternalism, person-centered>