Shared Decision Making (SDM) is a collaborative process between a patient and their clinician. SDM is crucial for fostering a patient’s sense of ownership in their course of recovery and promoting greater engagement in treatment, where LAIs may be a key component.
The traditional perception of LAIs in psychiatry as punitive or paternalistic (e.g., clinicians unilaterally directing treatment) presents a significant challenge. This view is often shared not only by patients but also by other treatment team members, complicating the discussion when a clinician determines that an LAI may be appropriate.
A recent study by Robinson et al. identified key systemic factors impacting the use of LAIs, which include: eligibility criteria, the role of inpatient use, support around medication decisions, inter-clinician communication, the infrastructure of the health system, and payer factors (e.g., insurance coverage).
When considering an LAI, the discussion must go beyond the typical presentation of risks and benefits for a new medication. Clinicians must actively explore the patient’s fears, goals, and questions about LAIs.
To most efficiently enable effective SDM, there must be:
When therapists, families, and community supports understand the rationale behind a LAI recommendation and the associated risks and benefits, the patient receives consistent information and support necessary to make a decision they are comfortable with.