Shared decision-making in the treatment of bipolar disorder: findings from a nationwide naturalistic cohort study in everyday clinical practice.

Background: Shared decision-making (SDM) is of increasing importance in mental health care, however, large studies on the effects of SDM in bipolar disorder (BD) are scarce.

Aim: To gain insight into the relationships between SDM, guideline concordance of treatments in everyday practice, satisfaction with care, and medication adherence in BD.

Method: In a nationwide observational study on the treatment of BD, patients were asked questions about their involvement in treatment. These questions were clustered according to the three-talk model (TTM) for SDM, which involves team talk, option talk, and decision talk. A composite concordance score for multimodal treatments was made, and satisfaction with care (score 1 to 10) and medication adherence (DAI-10) were measured.

Results: 839 patients with BD from various outpatient treatment centers were included. Patients were highly involved in decision-making. In multiple regression, team talk was significantly positively associated with guideline concordance (b = 5.10, p = .045), and decision talk was positively associated with satisfaction with care (b = 0.82, p < .001) and medication adherence (b = 1.18, p = .003).

Conclusion: Positive associations were found between SDM, guideline concordance, satisfaction with care, and medication adherence, suggesting that investing in these steps of the decision-making process together with patients and their significant others, will help to improve quality of care.