Applications in human-centered design: Shared-Decision Making for mental health treatment in primary care.

Abstract

Shared Decision Making (SDM) is heralded as a standard for patient-centered care, but implementation of SDM in routine mental health practice has proven difficult to achieve. Human-centered design (HCD) may hold promise for improving SDM implementation in busy clinical settings. This study describes applying HCD to develop an SDM documentation support tool intended to encourage successful use of SDM by mental health clinicians. This descriptive, proof-of-concept study utilized the Discover-Design-Build-Test HCD framework to simplify a comprehensive SDM protocol for mental health decision making. Implementation was piloted within multiple primary care clinics. The study consisted of three phases: information gathering (interviewing clinicians), solution generation and prototyping, and testing a final prototype in routine care settings. Our project proceeded through eight cycles of user design and feedback. Clinicians pilot tested the final product, a documentation note template incorporating SDM prompts and explanations. It is currently available for clinical use. Clinicians were able to use the HCD-redesigned SDM documentation note template intuitively, i.e., without explicit instruction. Leveraging buy-in from users throughout the entirety of the process (from problem investigation to solution discussions) created opportunities to tailor implementation strategies and may support ownership of the end-product by primary stakeholders. HCD may be a promising methodology for streamlining the adoption of complex clinical tasks like SDM.