Walking the path together: shared decision-making in families with multiple and enduring psychosocial problems

Abstract

Shared decision-making (SDM) with families experiencing multiple and enduring psychosocial problems is essential for providing appropriate care, yet challenging. The complexity of family problems and the involvement of multiple family members and professionals in SDM often lead to support that does not sufficiently match families’ needs and wishes. This dissertation examined why SDM with families and the professionals involved is so complex and what is needed to improve it, with a focus on integrated specialist teams in youth care. Data were collected through interviews with parents, youth, professionals, managers, and policy makers, as well as observations of multidisciplinary team meetings. The findings show SDM as a continuous process throughout care, in which a complex interplay between families’ and professionals’ context leads to challenges in SDM regarding families’ autonomy, mutual trust and multiple partnerships. Moreover, professionals need to balance team decision-making with decision-making with other care services. Therefore, SDM in families with complex problems requires a specific approach of professionals, supported by organizations and policy, investing time and attention to SDM throughout care, balancing professional expertise and family autonomy, and building trust and equal partnerships. Align interprofessional decision-making across changing care networks, while keeping the family at the center of decisions.