Objective In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician–patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. Methods This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician–patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Results Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. Conclusion We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Practice implications Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

Topic: This article reviews the literature on shared decision making in health and mental health and discusses tools in general health that are proposed for adaptation and use in mental health. Purpose: To offer findings from literature and a product development process to help inform/guide those who wish to create or implement materials for shared decision making in mental health. Sources used: Published literature and research on issues related to shared decision making in health and mental health, focus groups, and product testing. Conclusions: Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue.

Target four of the National Agenda for Achieving Better Outcomes for Children and Youth with Serious Emotional Disturbance focuses on collaborating with families to improve service delivery and results for their children. Moving toward this goal has necessitated the continuation of a paradigm shift that brought out this target as an important one in the first place, and that has highlighted the difference between family-focused and family-driven approaches. We discuss the history of the paradigm shift, the progress that has been made toward this goal of making families full collaborative partners in the care of their children, the elements and examples of effective systems of care, and the distance still to traverse toward fully realizing the goal of this strategic target.

Objective The objective of this exploratory paper is to describe several barriers in shared decision-making in an intercultural context. Methods Based on the prevailing literature on intercultural communication in medical settings, four conceptual barriers were described. When the conceptual barriers were described, they were compared with the results from semi-structured interviews with purposively selected physicians (n=18) and immigrant patients (n=13). Physicians differed in medical discipline (GPs, company doctors, an internist, a cardiologist, a gynaecologist, and an intern) and patients had different ethnic and immigration backgrounds. Results The following barriers were found: (1) physician and patient may not share the same linguistic background; (2) physician and patient may not share similar values about health and illness; (3) physician and patient may not have similar role expectations; and (4) physician and patient may have prejudices and do not speak to each other in an unbiased manner. Conclusion We conclude that due to these barriers, the transfer of information, the formulation of the diagnosis, and the discussion of treatment options are at stake and the shared decision-making process is impeded. Practice implications Improving physician ’s skills to recognize the communication limitations during shared decision-making as well as improving the skills to deal with the barriers may help to ameliorate shared decision-making in an intercultural setting.

http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2009-00580-011

It is now known that the onset of severe and recurring mental health problems begins for the most part before the age of 25: this provides a clear focus for preventive strategies and public mental health that are a feature of many health policy frameworks. The present distinction between child and adolescent mental health services and adult services at 16 or 18 does not fit easily with these data and the now well-documented problems of transition suggest that a fundamental review of services for young people is overdue. This supplement provides an overview of the epidemiological, conceptual and service structures for young people with emergent and existing mental health problems, and asks the question, ‘How should we design services for young people to promote prevention and service engagement, and to improve outcomes?’