Empowering Collaboration With Patients: Healthcare Staff's Perspectives on Conditions for Shared Decision-Making in Swedish Psychiatric Care

Abstract

Rationale

Shared decision-making (SDM) is advocated in psychiatric care to facilitate patients' engagement in treatment discussions about their own care. However, applying SDM in practice involves more than simply referring to an advocated method. It is therefore interesting to study healthcare professionals' perceptions and experiences of the conditions necessary for patients to truly participate in SDM.

Aim

To explore healthcare staff's experiences of patient involvement in psychiatric care, paying particular attention to perceived prerequisites, barriers and strategies relevant to shared decision-making.

Methods

This was an exploratory qualitative study, utilising an inductive approach. Twenty-eight psychiatric care professionals (21 women and 7 men; nurses (10), nurse's assistants (7), psychologists (2), psychotherapists/therapists (6), psychiatrists (1), junior doctors (1) and peer support (1)) participated in focus group interviews. Data was analysed using conventional content analysis, deriving coding categories directly from the transcripts without the influence of prior theoretical frameworks.

Results

Four main categories emerged: care relationship, patient resources, organization and strategies in patient meetings. Staff emphasised time as an overarching factor, which affected all the main categories. Trust, openness and mutual respect in the care relationship facilitate collaboration and patient involvement. Staff highlighted personalised care that aligns with patients' resource needs and values, supported by professionalism and transparency in communication. Beyond relational factors, organizational challenges—including time constraints and resource limitations—were barriers to patient involvement in SDM. Strategies such as motivational interviewing, documentation in patient records and care plans, and multidisciplinary teamwork were identified as facilitators.

Conclusions

Overall, the study illustrates that staff work towards a good care relationship to strengthen patients' engagement in SDM in psychiatric care. To truly apply patient involvement and SDM in practice, organizational support is needed, in the form of more time, more available resources and clearer care structures. In addition, organizational aspects, such as integrating patient involvement into system-level care planning, education and structures for decision-making processes, could further enhance patient involvement in SDM. Further research is needed to investigate how these perceived states translate into other cultural psychiatric contexts and how they are experienced by patients.