Enhancing shared decision making about discontinuation of antidepressant medication: A concept-mapping study in primary and secondary mental health care
until further notice
Number of pages
SourceBritish Journal of General Practice, 69, 688, (2019), pp. e777-e785
Article / Letter to editor
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Primary and Community Care
SW OZ BSI KLP
British Journal of General Practice
SubjectAll institutes and research themes of the Radboud University Medical Center; Experimental Psychopathology and Treatment; Radboudumc 13: Stress-related disorders DCMN: Donders Center for Medical Neuroscience; Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences
Background: The apparent rise of antidepressant use seems to be explained to a large extent by an increase in long-term use. Both professionals and patients appear reluctant to discontinue antidepressant medication (ADM). It is not known what factors determine this reluctance. Aim: This study aimed to identify factors that enable the shared decision-making process about discontinuation of ADM between long-term users and their GPs. Design and setting: Concept-mapping study of a purposive sample of both patients and professionals from primary and secondary mental health care in the Netherlands. Method: Concept mapping was used to conceptualise and structure the topics relevant to the discontinuation process from the perspective of both patients and professionals. Participants generated topics in brainstorming sessions and subsequently prioritised and sorted them. Multidimensional scaling and hierarchical cluster analyses were used for the cluster topics. Results: Thirty-seven patients and 27 professionals generated 50 separate topics. Hierarchical cluster analysis revealed six clusters of topics: 'Process of discontinuation', 'Expectations', 'Professional guidance', 'Current use', 'Environment', and 'Side effects'. Patients and professionals came up with largely similar topics. Nevertheless, a difference was found between these groups regarding the perceived importance of professional guidance. Conclusion: This study yielded an informed selection of the topics that seem most important to discuss when considering whether to discontinue ADM. As perspectives of both patients and professionals were combined, the topics may provide patients and GPs with a broader and more balanced scope of factors to consider, and thus facilitate a better shared decision-making process.
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