Problems and solutions in shared decision-making in coordinated individual care planning: multi-stakeholder perspectives in social and psychiatric care

This article examines the prerequisites for implementing shared decision-making (SDM) within coordinated individual care planning (CIP) for individuals with complex mental health needs in Sweden's mental health service delivery. Previous research has highlighted SDM as an appropriate approach for integrating into CIP due to its ability to provide a concrete framework for engaging users in collaborative decision-making throughout the CIP process. The study aims to investigate staff perspectives on SDM-supported CIP, utilizing a future workshop approach to elucidate challenges and generate solutions. Data were thus collected from a workshop held in one of the three Swedish regions designated as 'test-beds' for SDM in CIP, involving 18 participants. A large affinity diagram was built up showing the analysis and the affinities of staff's problems and solutions. Findings are formulated as propositions having a clear subject, highlighting the staff's perspectives. There are four main findings: two focusing clearly on problems staff have within and in-between their organizations. The third finding shows the staff's hesitation on working user-centred. This finding shows the difference of having a value, and acting according to this value, here highlighted by the level of user participation. The fourth main finding is solution-oriented, and concludes that the staff needs to work more user centred. Findings highlight challenges in achieving user involvement and shared responsibility in decision-making. A key challenge identified is the alignment between identified problems and proposed solutions, prompting questions about staff prioritization of issues they believe they can resolve.