1 - (SYM 78) Preferences for Involvement in Decision Making Among a Diverse Sample of Veterans with Psychosis

Background: Collaborative decision-making (Treichler et al., 2021) is an evidence-based approach that emphasizes patient power and participation at all levels of decision-making. This is particularly important for people with psychosis, who both historically and currently are more likely to experience coercive, iatrogenic, and/or non-evidence-based care. Initial evidence using a 3-item measure indicates that veterans with psychosis prefer to be involved in decision-making, especially Black veterans (Park et al., 2014). In this study, we: 1) expand understanding of involvement preferences using a vignette-based measure; 2) examine the relationship between preferences for and current levels of involvement; and 3) examine differences in preferences by sociodemographic group.

Methods: This secondary analysis combines data from two ongoing studies of veterans with serious mental illness; the first a clinical trial at a VA in Southern California (n = 19) and the second a national mixed methods study of Black veterans, Indigenous veterans, and veterans of color (n = 9). We are on track to reach a minimum total sample size of 60 by September 2023, but present our data to date here. Baseline quantitative data capturing preferences for treatment decision-making using six vignettes, current levels of involvement in decision-making, and demographics were included.

Results: Veterans prefered a collaborative approach to decision-making on average. However, veterans tended to prefer more autonomy when weighing risks and benefits (Cohen’s d = .926) and when making the final decision (Cohen’s d = .764), both relative to coming to a diagnosis. Additionally, veterans tended to prefer greater clinician involvement when asked about a situation where they perceive potential risk to be high relative to a situation about difficulty at work (Cohen’s d = .559). Preferences for involvement were not significantly correlated with current levels of involvement, r = .199.

Conclusions: Veterans prefer a collaborative approach to treatment decision-making, where they and their providers work closely together to make decisions. However, there is significant variability by veteran, type of decision, and step of the process. Current levels of involvement are not aligned with preferences, indicating an essential area for growth so that mental health care can meet the promise of person-centered, evidence-based care. This study demonstrates the need to invest in collaborative decision-making approaches at the veteran-clinician and veteran-system level.