Mental health care and pragmatic shared decision making in general practice: an interview study.

Abstract

Background: Healthcare providers in general practice are expected to deliver mental health care to patients through shared decision making (SDM). It is unclear whether they perceive their SDM to be affected by challenging circumstances in mental healthcare; for example, how waiting time for therapy plays a role.

Aim: To explore how healthcare providers and patients in general practice engage in SDM, given the challenging circumstances in mental health care.

Design & setting: A qualitative interview study in seven Dutch general practices.

Method: Semi-structured interviews were conducted with GPs (n = 9), practice nurses mental health (PNMHs; n = 8), and patients who sought mental health care (n = 18). The interviews were deductively and inductively thematically analysed.

Results: The participants mainly reported on SDM regarding treatment in secondary mental health care. The PNMHs explained they lack an overview of available treatments and waiting times in facilities. The PNMHs therefore instruct patients to also search for options themselves. Most patients found this approach burdensome, especially those new to mental health care. These patients were said to often express no strong treatment preferences and rely on advice by their healthcare providers. The GPs and PNMHs explained that in such cases, they often adopt a pragmatic approach and, for example, refer indecisive patients to facilities with little waiting times.

Conclusion: The healthcare providers and patients in general practice report that they adapt their approach to SDM in reaction to the circumstances in mental health care. Further exploration of how SDM is implemented and shaped by challenging circumstances across different healthcare settings is needed.