Mental healthcare and pragmatic shared decision-making in general practice: an interview study.

Background
Healthcare providers in general practice are expected to deliver mental healthcare to patients through shared decision-making (SDM). It is unclear if they perceive their SDM to be affected by challenging circumstances in mental healthcare, eg, how waiting time for therapy plays a role.

Aim
To explore how healthcare providers and patients in general practice engage in SDM, given the challenging circumstances in mental healthcare.

Design & setting
A qualitative interview study in seven Dutch general practices.

Method
Semi-structured interviews were conducted with general practitioners (GPs; N=9), practice nurses mental health (PNMHs; N=8) and patients that sought mental healthcare (N=18). The interviews were deductively and inductively thematically analyzed.

Results
The participants mainly reported on SDM regarding treatment in secondary mental healthcare. The PNMHs explained they lack an overview of available treatments and waiting times in facilities. The PNMHs therefore instruct patient to also search for options themselves. Most patients found this approach burdensome, especially those new to mental healthcare. These patients were said to often express no strong treatment preferences and rely on advice by their healthcare providers. The GPs and PNMHs explained that in such cases, they often adopt a pragmatic approach and for example refer indecisive patients to facilities with little waiting time.

Conclusion
The healthcare providers and patients in general practice experience they adapt their approach to SDM in reaction to the circumstances in mental healthcare. Further exploration of how SDM is implemented and shaped by challenging circumstances across different healthcare settings is needed.