Measures of Shared Decision Making for People With Mental Disorders and Limited Decisional Capacity: A Systematic Review.

OBJECTIVE: Shared decision making (SDM) is a health communication model to improve treatment decision making and is underused for people with mental health conditions and limited, impaired, or fluctuating decisional capacity. SDM measures are essential to enhancing the adoption and implementation of SDM practices, yet no tools or research findings exist that explicitly focus on measuring SDM with such patients. The aim of this review was to identify instruments that measure SDM involving individuals with mental health conditions and limited decisional capacity, their family members, and their health and social care providers. METHODS: A systematic review was performed by searching the PubMed, Embase, Web of Science, and PsycInfo databases. The authors included peer-reviewed, quantitative articles published in English during 2009-2022 that focused on adults (≥18 years old). All authors performed the screening independently. RESULTS: A total of 7,956 records were identified, six of which met the inclusion criteria for full-text review and five of which were analyzed (one full-text article was not available). No instruments were identified that measured forms of SDM involving patients with mental health conditions and limited, impaired, or fluctuating decisional capacity. CONCLUSIONS: Measurement instruments to address and assess SDM in health care-related communication processes involving individuals with a mental health condition and limited decisional capacity are needed.

Unaccompanied foreign minors and mental health: Implementation and evaluation of the RHS-15 screening procedure for unaccompanied foreign minors.

Background and objective: The recent notable increase in refugees' flows, with refugee children and adolescents relocating worldwide, posed severe challenges to the different national healthcare systems. Social groups such as refugees fleeing from their countries because of persecution, wars and violence are considered at high risk of developing mental health-related problems. Despite international and national policies legally regulating the reception process and protecting health-related rights, including the mental well-being of refugee migrants, there is a theoretical and applied need for evidence-based instruments and procedures to support mental health within this population. Recent evidence refers to the Refugee Health Screener-15 (RHS-15) as a reliable and valid instrument for the early detection of trauma-related mental health problems. In this scenario, this study aimed to test the RHS screening process within a multidisciplinary first intervention reception context for unaccompanied refugee minors. Design: The RHS-15 was administered with the support of cultural-linguistic mediators to 81 unaccompanied minor residents in a first intervention facility in Milan, Italy. This study aimed to assess psychometric characteristics, such as reliability, sensitivity and specificity feasibility and its implementation within a first intervention reception process. Results: The analysis resulted in the validation of the RHS in its 13-item format. The results highlighted and confirmed an efficient delivery, excellent reliability and a positive predictive and convergent validity of the 13-item version. Further analysis showed an excellent ability to avoid false negatives, although there was a clear tendency to identify false positives. Conclusions: The early identification of vulnerabilities among refugee minors is recommended to promote their long-term overall well-being. Integrating the screening results with additional observational elements and more specific diagnostic tools is recommended to gain a comprehensive perspective of the minors' well-being.

"What Bothers Me Most Is the Disparity between the Choices that People Have or Don't Have": A Qualitative Study on the Health Systems Responsiveness to Implementing the Assisted Decision-Making (Capacity) Act in Ireland.

OBJECTIVE: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. METHODS: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). RESULTS: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. CONCLUSIONS: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.

What are the mechanisms that support healthcare professionals to adopt assisted decision-making practice? A rapid realist review.

BACKGROUND: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) establishes a right to legal capacity for all people, including those with support needs. People with disabilities have a legal right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health. In Ireland, the Assisted Decision-Making (Capacity) Act (2015) ratifies the Convention and has established a legal framework for Assisted Decision Making (ADM). The main provisions of the Act are not yet implemented. Codes of Practice to guide health and social care professionals are currently being developed. Internationally, concerns are expressed that ADM implementation is poorly understood. Using realist synthesis, this study aims to identify Programme Theory (PT) that will inform ADM implementation in healthcare. METHODS: A Rapid Realist Review using collaborative methods was chosen to appraise relevant literature and engage knowledge users from Irish health and social care. The review was led by an expert panel of relevant stakeholders that developed the research question which asks, 'what mechanisms enable healthcare professionals to adopt ADM into practice?' To ensure the PT was inclusive of local contextual influences, five reference panels were conducted with healthcare professionals, family carers and people with dementia. PT was refined and tested iteratively through knowledge synthesis informed by forty-seven primary studies, reference panel discussions and expert panel refinement and consensus. RESULTS: The review has developed an explanatory PT on ADM implementation in healthcare practice. The review identified four implementation domains as significant. These are Personalisation of Health & ADM Service Provision, Culture & Leadership, Environmental & Social Re-structuring and Education, Training & Enablement. Each domain is presented as an explanatory PT statement using realist convention that identifies context, mechanism and outcome configurations. CONCLUSIONS: This realist review makes a unique contribution to this field. The PT can be applied by policymakers to inform intervention development and implementation strategy. It informs the imminent policy and practice developments in Ireland and has relevance for other worldwide healthcare systems dealing with similar legislative changes in line with UNCRPD.

Which instruments are used to measure shared, supported and assisted healthcare decision-making between patients who have limited, impaired or fluctuating capacity, their family carers and healthcare professionals? A systematic review protocol.

Background: Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient's values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined "Assisted" in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity. Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals. Methods: A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments. Discussion: The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals. Registration: PROSPERO CRD42018105360; registered on 10/08/2018.

(Dis)Obedience in U.S. American Young Adults: A New Way to Describe Authority Relationships.

The present research aims to investigate the psychosocial phenomena of obedience and disobedience in young adults residing in the United States, as a replication of a previous study by Pozzi, Fattori, Bocchiaro, and Alfieri (2014). We utilize social representation theory as a means to better understand and define (dis)obedience, a behavioral dimension of the concept of authority. The analysis was conducted using a concurrent mixed methods design. One hundred and fifty-one participants completed a self-report online questionnaire. The results indicate that participants see both obedience and disobedience as related to an authority. Obedience was mostly perceived as an ability to be responsive to laws, social norms, or physical authorities, as well as a positive social object. Disobedience, instead, was defined as a failure of a negative line of conduct. These results differ from previous research, contributing meaningfully and pragmatically to the theoretical debate on (dis)obedience. Theoretical and practical implications of these findings are discussed.

I am going to make the most out of it! Italian university Credit Mobility Students' social representations of alcohol use during study abroad experiences.

The aim was to explore shared representations of alcohol use in students who were to travel abroad to study. Focus group data from Italian students ( N = 69) were collected. Analyses used Grounded Theory Methodology and were informed by the four key components of Social Representation Theory (cognition, emotion, attitude and behavioural intentions). The study abroad experience was described as one that would involve an increase in alcohol consumption compared to pre-departure levels. Reasons given included greater social and leisure opportunities involving alcohol, reduced social control and features of the host country environment. Opportunities to intervene and address risky alcohol use in this group are discussed.

Social representation of therapeutic relationship among cognitive-behavioral psychotherapists.

The present study investigates the content and structure of the social representation (SR) that cognitive-behavioral (CBT) psychotherapists have of the therapeutic relationship (TR), through a discovery-oriented, mixed-methods approach. For this purpose, our reference point was social representation theory, in particular, the theory of the central nucleus (Abric, 2003; Moscovici, 1961). Data came from a sample of 63 CBT therapists. The results enabled us to identify a series of contents marking CBTs SR of the TR that overlap with the current pan-theoretical conceptualization of this construct. The results also allowed us to identify the complex, clear, and stratified organization of these contents, which are characteristics of a majority and of a minority of the sample studied. These results are discussed with regard of their theoretical, methodological, and practical implications. (PsycINFO Database Record

Authority Relationship From a Societal Perspective: Social Representations of Obedience and Disobedience in Austrian Young Adults.

Obedience and disobedience have always been salient issues for both civil society and social psychologists. Since Milgram's first studies on destructive obedience there has not been a bottom-up definition of what obedience and disobedience mean. The current study aimed at investigating the social representations young adults use to define and to co-construct knowledge about obedience and disobedience in Austria. One hundred fifty four (106 females, 68.8%) Austrian young adults (Mean age = 22.9; SD = 3.5) completed a mixed-method questionnaire comprising open-ended questions and free word associations. Overall obedience and disobedience are respectively defined as conformity and non-conformity to regulations, ranging from implicit social norms to explicit formal laws. Authority is multi-faceted and has a central role in orienting obedience and disobedience. Further fundamental determinants of the authority relationship and relevant application of the results are discussed in this paper.