Triadic shared decision making in emergency psychiatry: an explorative study

BMC Psychiatry, vol. 25, pp. 203

Abstract

BACKGROUND: This study aims to understand the complex triadic shared decision-making process in psychiatric emergency services, focusing on the choice between inpatient and outpatient care post-triage. It also identify scenarios where patient or significant others' preferences override clinical judgment. METHODS: Conducted in the greater Rotterdam area, Netherlands, this explorative study surveyed patient and significant others' preferences for voluntary or involuntary admission versus outpatient treatment, alongside professionals' clinical indications. Descriptive statistics were used to profile participants, and preference data were used to categorize groups, revealing patterns of agreement. RESULTS: Among 5680 assessments involving significant others, four groups emerged: agreement among the triad on in- or outpatient care (48.2%), patient disagrees (38.5%), significant others disagree (11.0%), and professionals disagree (2.3%). Professionals' recommendations were followed more frequently (57.0%) than patient (9.4%) or significant others' preferences (11.0%). CONCLUSIONS: We observed that consensus could often be reached among the members of the triad on inpatient or outpatient care following triage. Disagreements typically occurred when patients preferred outpatient care while others favoured inpatient care, or when significant others advocated for inpatient care while others preferred outpatient care. While professionals' recommendations held the most influence, they could be overridden in cases where valid criteria mandated involuntary care.

Authors 4

1. G. C. Roselie van Asperen

   Parnassia Groep

   Affiliation as printed

   Parnassia Psychiatric Institute

   Parnassia Psychiatric Institute, Dynamostraat 18, Rotterdam, 3083 AK, the Netherlands

2. A. I. Wierdsma

   Erasmus MC · Maastricht University · Vrije Universiteit Amsterdam

   Affiliation as printed

   Erasmus University Medical Center

   Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, P.O. Box 616, 6200 MD, the Netherlands

   Mental Health Institute Rivierduinen, Leiden, PO Box 405, 2300 AK, the Netherlands

   Psychology and Pedagogy, Vrije Universiteit Amsterdam, Amsterdam, P.O. Box 7057, 1007 MB, the Netherlands

3. R. F. P. Winter Aachen Mental Health Institute Rivierduinen

   Erasmus MC · GGZ Rivierduinen · Erasmus University Rotterdam

   Affiliation as printed

   Mental Health Institute Rivierduinen

   Epidemiological and Social Psychiatric Research institute, Department of Psychiatry, Erasmus University Medical Center, Rotterdam, PO Box 2040, 3000 CA, the Netherlands

4. Callista L. Mulder

   Parnassia Groep

   Affiliation as printed

   Parnassia Psychiatric Institute