Decision‐Making Across the Electroconvulsive Therapy Journey: Integrating User Personas and Patient Journey Mapping to Inform Individualised Psychiatric Nursing Care

This study explored patients' decision-making experiences, behaviours and needs across the electroconvulsive therapy (ECT) trajectory and constructed user personas and a journey map to guide stage-specific nursing care. ECT is effective for severe psychiatric disorders, yet premature discontinuation reaches 25.8%, with previous research largely overlooking the dynamic nature of decision-making and patient heterogeneity. Using a qualitative design, 17 Chinese psychiatric inpatients completed 19 semi-structured interviews with supplementary observation; data were analysed using conventional content analysis and affinity diagramming. Three user personas were identified: decision-dependent & trust-oriented, decision-dependent & conditional resistance, and proactive-participatory & self-activated. Decision-making was re-negotiated before, during and after ECT rather than being finalised at consent. Pain points evolved from pre-treatment information deficits and limited autonomy to treatment-phase interaction failures, feedback deficits and emotional isolation, to persistent post-treatment cognitive complaints, stigma and retrospective doubts about consent. Discontinuation was concentrated among patients who had regained decisional autonomy, suggesting that stopping ECT may reflect informed reappraisal rather than non-adherence. Overall, ECT decision-making is a dynamic process, and combining user personas with a journey map can enable stage-specific, personalised nursing support.