RESUMEN
PURPOSE: To develop a grounded theory-informed model explaining the decision-making process professionals in multi-disciplinary teams go through in deciding whether to administer electroconvulsive therapy (ECT) or not. METHODS: A grounded theory informed methodology was used to analyse the data offered by ten participants who had all been involved in the process of deciding if someone has ECT or not. RESULTS: The core categories, described as 'layers' in this research, 'personal and professional identity'; 'subjective vs objective'; 'Guidelines or Clinical Instinct?'; 'Someone has to take Responsibility' and 'the decision in action', were constructed from the data. CONCLUSIONS: The study describes a useful insight into the layers of the decision-making process that could be further considered in clinical settings. The model highlights the decision to give ECT that has many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process. The consultant psychiatrist and the patient were seen as holding most power in the process depending on whether the Mental Capacity Act (2005) or Mental Health Act (2007) was being followed. Patients were seen to experience a very different decision-making process dependant on the personal views of the professionals in relation to ECT.
Asunto(s)
Toma de Decisiones Clínicas/métodos , Terapia Electroconvulsiva/psicología , Personal de Salud/psicología , Grupo de Atención al Paciente , Femenino , Teoría Fundamentada , Humanos , MasculinoRESUMEN
OBJECTIVES: Family involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery. DESIGN: A conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis-stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches. SETTING: General adult acute mental health treatment. RESULTS: Six distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d'Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear 'patient-carer' relationships and the risk of perceived coercion. CONCLUSIONS: We conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.