What is shared decision making and how does it apply to using long-acting injectables (LAIs)?

Shared Decision Making (SDM) is a collaborative process between a patient and clinician. See this SMI Adviser tip for more information. SDM can lead to a sense of ownership in one’s course of recovery, with greater engagement in treatment, of which LAIs can be a key component.

The traditional view of LAIs in psychiatry as punitive and/or paternalistic (individuals being told what to do by clinicians) which may be shared by patients and other treatment team members presents a particular challenge to clinicians who determine that a LAI might be appropriate for a patient. A recent study by Robinson et al. identified the main factors impacting use of LAIs, which include: eligibility, inpatient use, support around medication decisions, inter-clinician communication, infrastructure of a health system, and payer factors (insurance coverage).

In addition to presenting the risks and benefits, as one would typically when considering a new medication, discussing the patient’s fears, goals and questions about LAIs is essential. Increasing access to information about LAIs, early in treatment, and across all members of the patient’s team will most efficiently enable effective SDM. When therapists, families, and community supports understand the reasons for a recommendation of using a LAI and the associates risks and benefits, the patient receives consistent information and support to a make decision s/he feels good about.

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