Missing Ingredients in Shared Decision-Making?

Shared decision-making (SDM) is a collaborative approach to making decisions in health care, and is a cornerstone of person-centered care. While providers are increasingly expected to utilize SDM in routine practice, widespread and sustainable implementation has proven difficult, especially in the care of individuals diagnosed with serious mental illnesses, and physicians and patients continue to identify barriers to effective collaboration. To date, SDM research has largely focused on the provision of high-quality clinical information from doctors to patients to the neglect of what may be the most important, and transformative, aspect of SDM-the relationship itself. In this forum, the lack of attention to the relationship in SDM research and practice will be explored, along with the relational qualities that need to be in place to implement SDM in the care of persons with serious mental illness based on the findings from a mixed-methods, participatory research project.

Self-efficacy and paradoxical dependence in chronic back pain: A qualitative analysis.

Objectives Patients with chronic back pain encounter considerable psychological and social challenges. In particular, the ever-evolving relationship between chronic back pain, sense of self-efficacy, and perceived role in interpersonal relationships merits further investigation. Methods We conducted in-person semi-structured interviews with 20 adult patients attending a specialized interventional spine pain clinic. The interview transcripts were subjected to inductive thematic analysis, and themes were labeled descriptively. Participant responses were intentionally not analyzed within the context of an existing theoretical framework, so that the content of participant responses would directly drive the emphasis of the findings. Results Participants described chronic back pain as a lonely struggle amid diminished capacity to work, enjoy leisure time, and contribute to social relationships. Feelings of needing to handle pain independently contrasted with the reality of having to rely on others for help, and this tension was a source of anxiety. Discussion The experience of chronic back pain was characterized by a conflict between the desire for self-efficacy, a sense of isolation, and the paradoxical need to rely on others. Interventions that allow patients to navigate this struggle by seeking help for their diminished capability, while retaining a sense of autonomy and self-worth, are indicated.