Shulamit Ramon, Helen Brooks, Sarah Rae and Mary-Jane O’Sullivan
This review paper will look at internationally existing publications in the English language on mental health shared decision making (SDM) implementation of a variety of…
Abstract
Purpose
This review paper will look at internationally existing publications in the English language on mental health shared decision making (SDM) implementation of a variety of interventions, including different methodologies and research methods, age groups and countries. The purpose of this paper is to provide an overview of: process, degree and outcomes of implementation; barriers and facilitators; perspectives on implementation by different stakeholders; analysis of the process of implementation in mental health services through the lenses of the normalisation process theory (NPT).
Design/methodology/approach
Following a targeted literature search the data were analysed in order to provide an overview of methodologies and methods applied in the articles, as well as of the variables listed above. Three different types of information were included: a content analysis of key issues, reflective understanding coming out of participating in implementation of an SDM project in the form of two narratives written by two key participants in an SDM pilot project and an NPT analysis of the process of implementation.
Findings
Only a minority of mental health SDM research focuses on implementation in everyday practice. It is possible and often desirable to achieve SDM in mental health services; it requires a low level of technology, it can save time once routinized, and it is based on enhancing therapeutic alliance, as well as service users’ motivation. Implementation requires an explicit policy decision, a clear procedure, and regular adherence to the aims and methods of implementation by all participants. These necessary and sufficient conditions are rarely met, due to the different levels of commitment to SDM and its process by the different key stakeholders, as well as due to competing providers’ objectives and the time allocated to achieving them.
Originality/value
The review indicates both the need to take into account the complexity of SDM, as well as future strategies for enhancing its implementation in everyday mental health practice. Perhaps because applying SDM reflects a major cultural change in mental health practice, current value attached to SDM among clinicians and service managers would need to be more positive, prominent and enduring to enable a greater degree of implementation.
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The purpose of this paper is to identify and describe, in a systematic way, the various academic discourses on the rationale for shared decision making (SDM) in mental health…
Abstract
Purpose
The purpose of this paper is to identify and describe, in a systematic way, the various academic discourses on the rationale for shared decision making (SDM) in mental health care, and so provide a comprehensive account of the ways in which this emerging field is being conceptualised in the research literature.
Design/methodology/approach
This study is a systematic review of peer-reviewed papers presenting a rationale for SDM in mental health. Relevant databases were searched from inception to July 2016. Data were analysed using a thematic analysis which aimed to identify and describe different discourses on the rationale for SDM in mental health care. Data were extracted into a standardised data extraction form which contained fields representing the developing thematic framework, study information and research methodology.
Findings
An initial search returned returned 1,616 papers, of which 175 were eligible for inclusion in this review. The authors developed ten distinct but interrelated themes which capture the various academic discourses on the rationale for SDM and represent some compelling arguments for SDM from a range of different perspectives including ethical, clinical, “user” focussed, economic and political. Dominant narratives in the literature linked SDM to the recovery moment and person-centred care, and adherence and engagement with mental health services.
Research limitations/implications
The authors are unable to make any conclusions about the strength of evidence for these rationales. The review was restricted to peer-reviewed publications, published in English.
Practical implications
The findings could be a useful framework to support the selection of outcome measures for SDM evaluations.
Originality/value
There have been no systematic reviews published in this area previously.
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Keryn Lian, Manes Eliacin, Robert Lempkowski, Marc Chason, Matthew O'Keefe and James Drewniak
The purpose of this paper is to present a new class of printed circuit board (PCB)‐based, radio frequency micro‐electro‐mechanical systems (RF‐MEMS) switches and to describe the…
Abstract
Purpose
The purpose of this paper is to present a new class of printed circuit board (PCB)‐based, radio frequency micro‐electro‐mechanical systems (RF‐MEMS) switches and to describe the packaging method and evaluate performance.
Design/methodology/approach
Traditional PCB materials and processes were combined with photolithographic high‐density interconnect (HDI) and MEMS to form 3D high‐performance RF switches.
Findings
A new type of MEMS RF switch has been developed on a PCB platform. Using processes analogous to those used for silicon MEMS, PCB, and HDI technologies were utilized to fabricate these 3D structures. The PCB‐based microstructures are “mil‐scale” rather than the “micro‐scale” of silicon MEMs. A co‐fabrication packaging method for the MEMS RF switch was also developed. The PCB‐based MEMS switches have demonstrated excellent RF performance and “hot‐switching” RF power‐handling capability. PCB‐based MEMS RF switches have the advantages of low cost and amenability to scale‐up for a high degree of integration.
Research limitations/implications
Further development on photo imageable dielectric materials will enable this technology to improve yield and processability.
Originality/value
The paper describes the development of PCB‐based MEMS RF switches. These elements will enable new applications and enhance the functionality of PCBs. They are also more amenable to system integration compared with silicon MEMS.
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This paper describes the use of the EE‐1 process for making high‐reliability multilayer boards. The EE‐1 process eliminates the need for flash electroless copper for…
Abstract
This paper describes the use of the EE‐1 process for making high‐reliability multilayer boards. The EE‐1 process eliminates the need for flash electroless copper for plated‐through holes. With this process, copper is directly electrodeposited onto an activated through‐hole. In addition to eliminating electroless deposition, the EE‐1 process claims to simplify process control, provide excellent copper‐to‐copper adhesion, and total backlight PTH coverage. Production experience with the process is extensive as it has been used at Photocircuits, Atlanta, since January 1986 in the fabrication of double‐sided boards. Test data of joint reliability and physical properties of copper in PTHs of multilayer boards obtained through this unique approach are presented. A special test, which directly measures the bond strength between through‐hole deposited copper and inner foil of multilayers, is also discussed.
Emma Kaminskiy, Simon Senner and Johannes Hamann
Shared decision making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users’ experiential knowledge, values and preferences…
Abstract
Purpose
Shared decision making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users’ experiential knowledge, values and preferences. The purpose of this paper is to review the existing literature pertaining to key stakeholders’ attitudes towards SDM in mental health. It examines whether perceived barriers and facilitators differ by group (e.g. service user, psychiatrist, nurse and social worker) and includes views of what facilitates and hinders the process for service users and practitioners.
Design/methodology/approach
This review adopts the principles of a qualitative research synthesis. A key word search of research published between 1990 and 2016 was undertaken. Qualitative, quantitative and mixed methods studies were included.
Findings
In total, 43 papers were included and several themes identified for service user and practitioner perspectives. Both practitioners and service users see SDM as an ethical imperative, and both groups highlight the need to be flexible in implementing SDM, suggesting it is context dependent. A range of challenges and barriers are presented by both practitioners and service users reflecting complex contextual and cultural features within which interactions in mental health take place. There were qualitative differences in what service users and practitioners describe as preventing or enabling SDM. The differences highlighted point towards different challenges and priorities in SDM for service users and practitioners.
Originality/value
The presentation of nuanced views and attitudes that practitioners and service users hold represent an important and under reported area and offer insight into the reasons for the gap between idealised policy and actual practice of SDM in mental health settings.
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Heather Castillo and Shulamit Ramon
While shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy…
Abstract
Purpose
While shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. The purpose of this paper to review existing developments, contemporary challenges, and evidence regarding SDM in mental health with a particular focus on the perspectives of service users.
Design/methodology/approach
This is a review of international papers analysed using narrative synthesis of relevant data bases.
Findings
The review shows significant barriers to the utilisation of SDM including ethical and legal frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance of power and feel they lack choices, being “done to” rather than “worked with”.
Practical implications
The paper also presents perspectives about how barriers can be overcome, and service users enabled to take back power and acknowledge their own expertise.
Originality/value
This review is the first with a particular focus on the perspectives of service users and SDM.
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Abstract
Details
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The Second Brazilian Printed Circuit Association Seminar will take place in Rio de Janeiro from 21–23 September 1988. Papers will be presented on the following topics:
Vanessa Pinfold, Ceri Dare, Sarah Hamilton, Harminder Kaur, Ruth Lambley, Vicky Nicholls, Irene Petersen, Paulina Szymczynska, Charlotte Walker and Fiona Stevenson
The purpose of this paper is to understand how women with a diagnosis of schizophrenia or bipolar disorder approach medication decision making in pregnancy.
Abstract
Purpose
The purpose of this paper is to understand how women with a diagnosis of schizophrenia or bipolar disorder approach medication decision making in pregnancy.
Design/methodology/approach
The study was co-produced by university academics and charity-based researchers. Semi-structured interviews were conducted by three peer researchers who have used anti-psychotic medication and were of child bearing age. Participants were women with children under five, who had taken anti-psychotic medication in the 12 months before pregnancy. In total, 12 women were recruited through social media and snowball techniques. Data were analyzed following a three-stage process.
Findings
The accounts highlighted decisional uncertainty, with medication decisions situated among multiple sources of influence from self and others. Women retained strong feelings of personal ownership for their decisions, whilst also seeking out clinical opinion and accepting they had constrained choices. Two styles of decision making emerged: shared and independent. Shared decision making involved open discussion, active permission seeking, negotiation and coercion. Independent women-led decision making was not always congruent with medical opinion, increasing pressure on women and impacting pregnancy experiences. A common sense self-regulation model explaining management of health threats resonated with women’s accounts.
Practical implications
Women should be helped to manage decisional conflict and the emotional impact of decision making including long term feelings of guilt. Women experienced interactions with clinicians as lacking opportunities for enhanced support except in specialist perinatal services. This is an area that should be considered in staff training, supervision, appraisal and organization review.
Originality/value
This paper uses data collected in a co-produced research study including peer researchers.
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Yaara Zisman-Ilani, Erin Barnett, Juliette Harik, Anthony Pavlo and Maria O’Connell
Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange…
Abstract
Purpose
Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health.
Design/methodology/approach
The authors conducted a systematic literature search using the Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors included studies of participants with a mental illness facing a mental health care decision, their caregivers, and providers.
Findings
A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting.
Originality/value
The review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.