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A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder

Community Mental Health Journal volume 53, pages 958–971 (2017)Cite this article

Abstract

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.

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Acknowledgements

The authors wish to thank all the clinicians who willingly donated their time to participate in this research.

Funding

This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney.

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Affiliations

  1. School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia

    Alana Fisher, Louise Sharpe, Rebekah Laidsaar-Powell & Ilona Juraskova

  2. Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, Camperdown, NSW, 2006, Australia

    Alana Fisher, Rebekah Laidsaar-Powell & Ilona Juraskova

  3. School of Psychiatry, University of New South Wales, Sydney, NSW, 2031, Australia

    Vijaya Manicavasagar

  4. Black Dog Institute, University of New South Wales, Sydney, NSW, 2031, Australia

    Vijaya Manicavasagar

Authors
  1. Alana Fisher
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  2. Vijaya Manicavasagar
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  3. Louise Sharpe
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  4. Rebekah Laidsaar-Powell
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  5. Ilona Juraskova
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Correspondence to Alana Fisher.

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Appendix A: Clinician Interview Items

Appendix A: Clinician Interview Items

General discussion:

  1. 1)

    Types of decisions:

    1. a)

      What are the kinds of decisions you have (had) to make with patients managing their Bipolar II Disorder?

    2. b)

      What kinds of treatment decisions do you spend time discussing with patients?

  2. 2)

    Decisional conflict:

    1. a)

      Which decisions have been the most difficult to make with patients managing their Bipolar II Disorder?

    2. b)

      What has made these decisions difficult?

    3. c)

      What is needed to make decision-making less difficult?

  3. 3)

    Decision support (barriers and facilitators):

    1. a)

      How do you usually make decisions about treatment for Bipolar II Disorder?

    2. b)

      How do you support your patients’ decision-making about treatment? How about their family and friends?

  4. 4)

    Suggestions for resources.

    1. a)

      Is there anything else, for example information booklets or online exercises, which would help better support you in your decision-making about treatment?

    2. b)

      What would you like these to look like?

  5. 5)

    Patient/family involvement:

    1. a)

      Who is involved in the decision-making process about patients’ treatment?

    2. b)

      What do you think about patients participating in decisions? Others’ involvement?

    3. c)

      Are there any challenges to involving patients in decision-making about treatment?

Focused discussion:

  1. 6)

    Decision-making stages:

    Can you give me a couple of examples of a decision that needed to be made about a patient’s Bipolar II Disorder while in consultation with them. Keep those examples in mind.......

    Who aside from you and the patient is generally present during these consultations?

  1. 7)

    Information gathering:

    1. a)

      Outside these consultations, are you aware of patients seeking information about their illness and treatment?

  2. 8)

    Information exchange:

    1. a)

      Can you tell me about how the information about different options is discussed in the consultation?

  3. 9)

    Deliberation (process of expressing/discussing treatment preferences):

    1. a)

      Once the information has been discussed, what happens when the different options are being weighed up within consultations?

    2. b)

      Do you and the patient (and their family member) talk or think more about options after this consultation? What happens generally?

  4. 10)

    Decision:

    1. a)

      When it comes down to making the decision, how involved are you (is the patient/ their family)?

    2. b)

      When it comes down to actually making the decision, who do you think has the most influence?

  5. 11)

    Decisional monitoring:

    1. a)

      Have you reflected any more about the decisions made in these consultations?

  6. 12)

    Reflecting on decision making process:

    1. a)

      Do you feel anything was missing (or left out) in the decision-making process? If so, what?

    2. b)

      Did anything about the decision-making process not meet your expectations? If so, what?

  7. 13)

    Decision-aid:

    1. a)

      We are looking to develop a decision-support resource to help patients and family make decisions about their treatment. What sort of information would be helpful to include?

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Fisher, A., Manicavasagar, V., Sharpe, L. et al. A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder. Community Ment Health J 53, 958–971 (2017). https://doi.org/10.1007/s10597-016-0077-4

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  • DOI: https://doi.org/10.1007/s10597-016-0077-4

Keywords

  • Bipolar II disorder
  • Treatment decision-making
  • Qualitative
  • Clinician attitudes
  • Patient involvement
  • Family involvement