Centre for Youth Mental Health - Theses
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ItemTreatment decision making for young people diagnosed with major depressive disorders( 2011)Adolescence is a crucial period of risk for depression, with one in every five people experiencing a depressive episode before the time they are 18 years old. Engaging young people in effective treatment during this time is essential to prevent potential long-term negative impact. Guidelines advocate for young people to be involved in treatment decision making, both in terms of receiving information about treatment options, and also making choices about their own care. These recommendations are in line with a model of decision making called ‘shared decision making’ (SDM), one of several models of medical decision making. Yet little is known about processes related to treatment decision making in this age group or young people’s preferred model of treatment decision making. What little literature that exists suggests young people would value involvement in treatment decision making and that such involvement may enhance engagement. In order to address this gap in our understanding of treatment decision making in young people, semi-structured, qualitative interviews were conducted with clients (n=10), caregivers (n=5) and clinicians (n=22) about their experiences and beliefs about treatment decision making for young people diagnosed with major depressive disorder (MDD). Thematic analysis was used to identify key themes in the data. Clients and caregivers reported a range of experiences regarding how involved they were in treatment decision making, yet, consistent with the small body of literature identified, they all wanted involvement of some sort. Clinicians also wanted clients, and caregivers as appropriate, to be involved. All participants (clients, caregivers and clinicians) reported a lack of information exchange (e.g. information about potential risks and benefits of different treatment options) and wanted resources to fill this gap. Overall, the findings from these interviews indicated a preference for involvement in treatment decision making that was in line with a SDM model. In response, an evidence-based decision aid that facilitates SDM was developed for young people diagnosed with MDD who are faced with the decision about which treatment option is best for them. The decision aid was developed according to international standards, and included field-testing with clients (n=5) and clinicians (n=3), who all found the tool acceptable and useful. The current study provides the basis from which an understanding of treatment decision making for young people diagnosed with MDD can be further built, and from which additional resources can be developed and tested in order to contribute to the emerging field of youth SDM. Approaches that support young people to make evidence-based and preference-based treatment decisions have the potential to increase guideline-concordant care, satisfaction, adherence and clinical outcomes.