DataSheet_2_Giving Patients Choices During Involuntary Admission: A New Intervention.pdf

Background: People who receive involuntary treatment are some of the most vulnerable in psychiatric services. They are more likely to have poorer social and clinical outcomes and to be disillusioned with and disengaged from care. Research indicates that patients’ experience in the first week of involuntary treatment is a critical period: a better experience of care in the first week predicts better quality of life and reduced readmission 1 year later. Patients have identified involvement in clinical decisions as key to improving their experience of care. The aim of this study was to test the feasibility and acceptability of an intervention to facilitate involvement in decision making for involuntary inpatients called OPeNS (Options, Preferences, Negotiate, and Summarise).
Methods: This was a mixed method study. The OPeNS intervention was developed based on previous research carried out by a multidisciplinary team. Clinicians were trained to deliver it to involuntary inpatients. Feasibility indices (rates of participation in the intervention and time required to deliver it) were collected. Patients (N = 14) and clinicians (N = 5) provided qualitative data on their experience of the intervention in semi-structured interviews which were analysed using thematic analysis.
Results: The OPeNS intervention was found to be acceptable by both patients and clinicians and feasible to conduct within the first week of involuntary treatment. Patients’ and clinicians’ experiences of the intervention fall into two themes: ‘Enabling a different dynamic’ and ‘Clashing with usual practices and priorities’.
Conclusion: The OPeNS intervention provides a structure that can be used by clinicians across disciplines to facilitate involving involuntary patients in decision making. Although challenges related to changing usual practices were identified, the intervention was received positively and was feasible to conduct in the first week of involuntary treatment.

背景：接受强制治疗的群体是精神卫生服务中最脆弱的人群之一。他们往往社会功能与临床结局更差，且易对护理产生失望情绪，进而脱离照护体系。研究表明，强制治疗首周的患者体验是关键窗口期：首周获得更优质的护理体验，可预示患者后续生活质量更高，且1年内再入院率更低。患者普遍认为，参与临床决策是改善自身护理体验的核心要素。本研究旨在评估一项针对强制住院患者、用于促进其参与临床决策的干预方案的可行性与可接受性，该方案命名为OPeNS（Options, Preferences, Negotiate, and Summarise）。方法：本研究为混合方法研究。OPeNS干预方案由多学科团队基于既往研究开发而成。临床医护人员接受了针对强制住院患者实施该方案的相关培训。研究收集了可行性相关指标，包括干预方案参与率及方案实施所需时长。招募14名患者与5名临床医护人员，通过半结构化访谈收集其对该干预方案的体验质性数据，并采用主题分析法对数据进行分析。结果：研究结果显示，患者与临床医护人员均认可OPeNS干预方案，且该方案可在强制治疗首周内顺利实施。患者与医护人员对该干预方案的体验可归纳为两大主题：“构建差异化互动模式”与“与常规诊疗流程及优先级存在冲突”。结论：OPeNS干预方案提供了一套标准化框架，可供多学科临床医护人员使用，以推动强制住院患者参与临床决策。尽管研究发现了与变革常规诊疗流程相关的挑战，但该干预方案仍获得了积极反馈，且可在强制治疗首周内顺利实施。