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How are decisions made?
How do psychiatrists and patients negotiate
about medication?
This study recorded 100 consultations during
which psychiatrists discussed medication with patients. The
analysis identified what makes for good consensual decision-making.
The results are helping to educate psychiatrists about how best to
engage in these negotiations.
Detailed information
Title: How are decisions made about
prescribing of anti-psychotic drugs for psychiatric
outpatients?
Funded from 2003 to 2006 by Eli Lilly.
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Background to the study
- Randomised controls trials (RCTs) provide valuable evidence
about the effectiveness of medication
- There are great differences between the circumstances of an RCT
and those of the real-life clinical setting
- Little is known about how psychiatrists and their patients
negotiate decisions about medication
Study aims
- To understand better how prescribing decisions are made in
psychiatric outpatient consultations
Method
- Highly detailed conversation analysis of 100 tape recorded
outpatient consultations
- Participant-observation on 3 wards (inner London, outer London,
South East England)
- Observation & interviews with patients and staff
- Findings have been disseminated widely and fed into training
materials and courses for psychiatrists
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Publications
- Chaplin, R., Lelliott, P., Quirk, A. & Seale, C. (2007)
‘Negotiating styles adopted by consultant psychiatrists when
prescribing antipsychotics’, Advances in Psychiatric
Treatment 13, 43 – 50
- Quirk, A., Chaplin, R., Lelliott, P. & Seale, C.
(2009) The negotiation of prescribing decisions: some
good practice issues. In N. Harris, J. Baker & R. Gray
(eds) Medicines Management in Mental Health. Wiley-Blackwell.
- Quirk, A., Chaplin, R., Lelliott, P. & Seale, C. How
pressure is applied in ‘negotiated’ decisions about
medication. Sociology of Health & Illness, in
press.
- Quirk, A., Chaplin, R., Lelliott, P. & Seale, C.
Communication about adherence to long-term anti-psychotic
prescribing. British Journal of Psychiatry.
Submitted.
- Seale, C., Chaplin, R., Lelliott, P. & Quirk, A. (2007)
‘Antipsychotic medication, sedation and mental clouding: An
observational study of psychiatric consultations’, Social
Science & Medicine, 65(4), 698-711.
- Seale, S., Chaplin, R., Lelliott, .P, & Quirk, A. (2006)
Sharing decisions in consultations involving anti-psychotic
medication: a qualitative study of psychiatrists’ experiences.
Social Science & Medicine, 62: 2861-2873.
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| Health Services Research, Royal College of Psychiatrists, 4th
Floor Standon House, 21 Mansell Street, London E1
8AA |
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