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Table 1 Clinician barriers and facilitators to SDM using the TDF [10]

From: Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework

COM-B TDF Barriers and facilitators
Capability Knowledge An awareness of the philosophy of SDM but not always the term
   A lack of knowledge regarding care and treatment options
  Cognitive and interpersonal skills The overlap between core therapeutic skills and skills needed for SDM
   Negotiation and containment as ‘new’ skills needed for SDM
  Memory, attention, and decision making processes The availability of options may affect what is presented to the young person and family
  Behavioural regulation A lack of clarity around whether there are guidelines and protocols for SDM
   Reviews of treatment and goals, whilst considered important, are conducted sporadically
Opportunity Environmental context and resources Facilities not conducive to SDM
   Limited or a lack of psychological interventions for SDM
   Administration and time constraints that inhibit SDM
   Procedural influences stop SDM
  Social influences Team members positively and negatively influencing decisions
   Dominating parents
Motivation Professional role and identity Shared decision making is something CAMHS clinicians ‘do’
   Overruling a young person’s wishes due to professional standards
  Beliefs about consequences Shared decision making empowers young people and families
   Shared decision making takes too much time
   Shared decision making can make psychological problems worse
  Beliefs about capabilities Feeling confident engaging in SDM
   Feeling less confident due to a lack of knowledge around options
  Emotion Feeling overwhelmed which inhibits SDM