Elizabeth C Thomas1, John Suarez1, Alicia Lucksted2, Laura Siminoff1, Irene Hurford3, Lisa Dixon4, Maria O'Connell5, Mark Salzer1. 1. College of Public Health, Temple University, Philadelphia, Pennsylvania, USA. 2. School of Medicine, University of Maryland, Baltimore, Maryland, USA. 3. Irene Hurford MD PLLC, Jenkintown, Pennsylvania, USA. 4. Department of Psychiatry, Columbia University, New York, New York, USA. 5. Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
Abstract
AIM: Many emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision-making needs about use of mental health services. A basic understanding of the decision-making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision-making. METHODS: Twenty emerging adults with early psychosis were administered semistructured interviews to capture treatment decision-making experiences during the first six months after enrolment in an EIP program. Interviews were audio-recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus. RESULTS: Emerging adults identified numerous decisions faced after EIP enrolment. Decisions pertaining to life and treatment goals and to starting and continuing psychiatric medication were commonly selected as the most difficult/complicated. Decision-making barriers included not having the right amount or type of information/knowledge, social factors (e.g., lacking social support, opposition/pressure), lacking internal resources (e.g., cognitive and communication skills, self-efficacy, motivation) and unappealing options. Obtaining information/knowledge, social supports (e.g., connection/trust, learning from others' experiences, encouragement), considering personal values, and time were decision-making facilitators. CONCLUSIONS: This study informs development and optimization of interventions to support decision-making among emerging adults with early psychosis, which may promote service engagement.
AIM: Many emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision-making needs about use of mental health services. A basic understanding of the decision-making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision-making. METHODS: Twenty emerging adults with early psychosis were administered semistructured interviews to capture treatment decision-making experiences during the first six months after enrolment in an EIP program. Interviews were audio-recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus. RESULTS: Emerging adults identified numerous decisions faced after EIP enrolment. Decisions pertaining to life and treatment goals and to starting and continuing psychiatric medication were commonly selected as the most difficult/complicated. Decision-making barriers included not having the right amount or type of information/knowledge, social factors (e.g., lacking social support, opposition/pressure), lacking internal resources (e.g., cognitive and communication skills, self-efficacy, motivation) and unappealing options. Obtaining information/knowledge, social supports (e.g., connection/trust, learning from others' experiences, encouragement), considering personal values, and time were decision-making facilitators. CONCLUSIONS: This study informs development and optimization of interventions to support decision-making among emerging adults with early psychosis, which may promote service engagement.
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Authors: Natalie Joseph-Williams; Robert Newcombe; Mary Politi; Marie-Anne Durand; Stephanie Sivell; Dawn Stacey; Annette O'Connor; Robert J Volk; Adrian Edwards; Carol Bennett; Michael Pignone; Richard Thomson; Glyn Elwyn Journal: Med Decis Making Date: 2013-08-20 Impact factor: 2.583
Authors: Dawn Stacey; Jennifer Kryworuchko; Jeff Belkora; B Joyce Davison; Marie-Anne Durand; Karen B Eden; Aubri S Hoffman; Mirjam Koerner; France Légaré; Marie-Chantal Loiselle; Richard L Street Journal: BMC Med Inform Decis Mak Date: 2013-11-29 Impact factor: 2.796