A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder
- 542 Downloads
This study qualitatively explored clinicians’ views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.
KeywordsBipolar II disorder Treatment decision-making Qualitative Clinician attitudes Patient involvement Family involvement
The authors wish to thank all the clinicians who willingly donated their time to participate in this research.
This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- De las Cuevas, C., Penate, W., & de Rivera, L. (2014a). To what extent is treatment adherence of psychiatric patients influenced by their participation in shared decision making? Patient Preference and Adherence, 8, 1547–1553.Google Scholar
- De las Cuevas, C., Peñate, W., & de Rivera, L. (2014b). Psychiatric patients’ preferences and experiences in clinical decision-making: Examining concordance and correlates of patients’ preferences. Patient Education and Counseling, 96(2), 222–228.Google Scholar
- Fisher, A., Manicavasagar, V., Kiln, F., & Juraskova, I. (2016a). Communication and decision-making in mental health: A systematic review focusing on bipolar disorder. Patient Education and Counseling, 99(7), 1106–1120.Google Scholar
- Fisher, A., Manicavasagar, V., Sharpe, L., & Laidsaar-Powell, R. (2016b). Identifying and addressing barriers to treatment decision-making in bipolar II disorder: Clinicians’ perspective. (Under review)Google Scholar
- Jacobsen, M., & O’Connor, A. (1999). Population needs assessment: A workbook for assessing patients’ and practitioners’ decision making needs. Ottawa: Ottawa Hospital Research Institute.Google Scholar
- Judd, L. L., Akiskal, H. S., Schettler, P. J., Coryell, W., Endicott, J., Maser, J. D., & Keller, M. B. (2003a). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Archives of General Psychiatry, 60(3), 261–269.Google Scholar
- Judd, L. L., Schettler, P. J., Akiskal, H. S., Maser, J., Coryell, W., Solomon, D., & Keller, M. (2003b). Long-term symptomatic status of bipolar I versus bipolar II disorders. The International Journal of Neuropsychopharmacology, 6(02), 127–137.Google Scholar
- Laidsaar-Powell, R., Butow, P., Bu, S., Charles, C., Gafni, A., Fisher, A., & Juraskova, I. (2016). Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences. Patient Education and Counseling, 99(7), 1146–1155.CrossRefPubMedGoogle Scholar
- McInerney, S. J., & Kennedy, S. H. (2014). Review of evidence for use of antidepressants in bipolar depression. The primary care companion for CNS disorders, 16(5). doi: 10.4088/PCC.14r01653.
- Nolan, M. T., Hughes, M., Narendra, D. P., Sood, J. R., Terry, P. B., Astrow, A. B., & Sulmasy, D. P. (2005). When patients lack capacity: The roles that patients with terminal diagnoses would choose for their physicians and loved ones in making medical decisions. Journal of Pain and Symptom Management, 30(4), 342–353.CrossRefPubMedPubMedCentralGoogle Scholar
- Ritchie, J., Lewis, J., Nicholls, C. M., & Ormston, R. (2013). Qualitative research practice: A guide for social science students and researchers. Thousand Oaks: Sage.Google Scholar
- Ritchie, J., & Spencer, L. (2002). Qualitative data analysis for applied policy research The qualitative researcher’s companion (pp. 305–329). Thousand Oaks: Sage Publications.Google Scholar
- Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Beaulieu, S., Alda, M., & Sharma, V. (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: Update 2013. Bipolar Disorders, 15(1), 1–44.CrossRefPubMedGoogle Scholar