Walking the Path Together: A Qualitative Analysis on How to Overcome Challenges of Shared Decision-Making in Families with Multiple and Enduring Psychosocial Problems

Shared decision-making (SDM) in families facing multiple and enduring psychosocial problems across life domains is hampered by the diverse needs and preferences of multiple family members, as well as differing opinions and roles of the various professionals and care services involved. In this qualitative study, we explored challenges of SDM when aiming to provide integrated care to families with complex psychosocial needs, and the facilitating strategies professionals and families adopt to overcome these challenges. Semi-structured interviews were conducted with 18 parents, 3 youth and 22 professionals. Moreover, 40 observations of multidisciplinary team case meetings of Specialist Integrated care Teams were conducted. Combining thematic, context, and strategy coding provided an in-depth understanding of SDM in this specific context. In our analyses, we identified challenges in SDM from the interplay of families’ and professionals’ context as well as facilitating strategies, described in three themes: (1) balancing roles of families and professionals, (2) trust and collaboration in making decisions, and (3) multiple stakeholders. To overcome these challenges, professionals and families are recommended to approach SDM as a continuous cycle throughout the care process, foster continuity in relationships, and engage in a human-to-human partnership with families.