Conversation topics in psychiatric consultations conducted with and without a shared decision-making tool: A qualitative content analysis

Abstract

Objectives: To identify 1) conversation topics, 2) who initiated the topics, and 3) differences in topics with and without the use of a shared decision-making (SDM) tool in psychiatric outpatient consultations.

Methods: We conducted qualitative content analysis of audio-recorded and transcribed data of psychiatric outpatient consultations. We included 52 participants - 25 in the SDM group and 27 in the treatment as usual (TAU) group - and 104 consultations were analyzed, two per participant. The word count per topic was calculated using the transcripts.

Results: Five categories for 28 topics were generated. The categories and percentages of word count were: (1) symptoms: 26.1%, (2) life: 37.4%, (3) treatment/service use: 16.3%, (4) global state/goal: 7.3%, and (5) others: 12.9%. The SDM tool significantly increased the overall conversation word count and consultation time. No significant difference was observed for the topic distribution between the two groups.

Conclusion: Daily life issues - especially those related to work - were the main topics discussed in psychiatric consultations. The SDM tool seems to facilitate discussion of patients' concerns, but the topic distribution is likely to be similar regardless of whether or not the SDM tool was used.

Practice implications: Outpatient psychiatrists are expected to effectively address life-related issues.

Keywords: Communication in psychiatry; Conversation topic; Doctor–patient communication; Psychiatric outpatient consultation; Qualitative content analysis; Shared decision-making tools.