SHARED DECISION MAKING IN ANTIDEPRESSANT USE AMONG PATIENTS WITH MAJOR DEPRESSIVE DISORDER: TOOL ADAPTATION AND IMPLEMENTATION

SYAHRIR BIN ZAINI, SYAHRIR (2020) SHARED DECISION MAKING IN ANTIDEPRESSANT USE AMONG PATIENTS WITH MAJOR DEPRESSIVE DISORDER: TOOL ADAPTATION AND IMPLEMENTATION. Doctoral thesis, UNIVERSITI MALAYA.

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Abstract

Patient-centred care (PCC), patient engagement, and shared decision-making (SDM) are increasingly known as contributors to health services quality improvement. This study aims to adapt a shared decision-making (SDM) tool, which is relevant, systematic and easy to administer by psychiatrists during their consultations on the antidepressant use among patients with major depressive disorder (MDD). There are four phases in this study, which include qualitative and quantitative methods. The first phase was related to the scoping and narrative review of the literature. The findings from this phase were brought forward to the subsequent phases of this study. Then, the second phase followed with the focus group discussions study (FGD) involving patients and psychiatrists in a psychiatric department of University Malaya Medical Centre (UMMC). This qualitative study aimed to develop a strategic tool that was informed by psychiatrists’ and patients’ perspectives toward the promotion and implementation of SDM in the use of antidepressants among patients with MDD. Next, the third phase of this study included a multicentre cross-sectional study of 15 public and private psychiatric outpatient clinics to investigate the depressive disorder patients’ and psychiatrists’ perceived involvement of the SDM process during outpatient clinic consultations. Finally, during the fourth phase of this study, the involved psychiatrists in the previous phase study were invited to become the clinical expert panels in reviewing the feedback of the last multicentre study. The scoping review of the literature was conducted using PubMed, CINAHL and Cochrane. Out of 494 records identified, a total of 13 articles were included in the scoping review. SDM was found to be a critical feature of patient-centred communication. The narrative review also provided some useful information regarding the use of antidepressants for physical and psychological symptoms in cancer. From the FGDs, patients’ and doctors’ views on providing the information needed for SDM practice were organized into six major themes; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacists. For the multicentre study, a total of 160 patients (60 males and 100 females, mean age ± SD: 37.1 ± 14.2 years) were included as the subjects of this study. SDM-Q-9 total score (median score ± SD: 82.2 ± 15.4 transformed scores) indicated a high degree of perceived involvement, with statistically significant different perceptions, stratified by ethnicity, religion and employment status. Differences were further observed when item by item analysis of SDM-Q-9 and SDM-Q-Doc was applied. Finally, a booklet of scripts for doctors to conduct SDM in the use of antidepressants among MDD patients had been produced by an expert panel in the fourth phase of this study. A relevant, systematic and easy to administer booklet of scripts for psychiatrists to conduct SDM had been adapted from thorough four phases of the study. Future research should include the development of patient decision aid, specific to this type of population.

Item Type:	Thesis (Doctoral)
Subjects:	H Social Sciences > H Social Sciences (General)
Divisions:	Universiti > Universiti Malaya (UM)
Depositing User:	Encik Mohd Zulkarnain Hassan bin Mohd Zainudin
Date Deposited:	16 Jan 2026 09:59
Last Modified:	16 Jan 2026 09:59
URI:	https://repositori.mohe.gov.my/id/eprint/142

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