Aspectos conceptuales sobre el proceso de decisión compartida en salud mental

  1. José María Villagrán 1
  2. Ignacio Lara Ruiz-Granados 2
  3. Francisco González Saiz 3
  1. 1 Unidad de Hospitalización Psiquiátrica
  2. 2 Unidad de Salud Mental Comunitaria Sierra de Cádiz
  3. 3 Hospital de Jerez de La Frontera
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Revista:
Revista de la Asociación Española de Neuropsiquiatría

ISSN: 0211-5735

Año de publicación: 2015

Volumen: 35

Número: 127

Páginas: 455-472

Tipo: Artículo

DOI: 10.4321/S0211-57352015000300002 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Revista de la Asociación Española de Neuropsiquiatría

Resumen

Uno de los cambios más importantes en la atención sanitaria de las últimas décadas, en lo que a las decisiones terapéuticas se refiere, ha sido la transición desde un modelo centrado en la enfermedad a uno centrado en el paciente. Esto conlleva la progresiva sustitución de una aproximación paternalista por una más deliberativa y, en relación a los tratamientos farmacológicos, del concepto de cumplimiento o adherencia al de concordancia o acuerdo terapéutico. El concepto de concordancia, por su parte, ha sido contemplado como el objetivo final de un proceso de negociación y corresponsabilidad en la decisión de elegir un tratamiento al que se ha denominado proceso de decisión compartida (PDC) (shared decision making). Hasta el momento, el PDC ha sido escasamente implantado en trastornos mentales graves, cuando no contestado como inadecuado dada la presunta alteración de la capacidad del paciente psiquiátrico gravemente enfermo para tomar decisiones. Sin embargo, esta incapacidad no siempre está presente por lo que la decisión compartida debe contemplarse como premisa y no como excepción. El PDC implica la implantación de un procedimiento en etapas (asociación médicopaciente, información sobre opciones, pros y contras, deliberación sobre las mismas y su relación con valores y preferencias del paciente, decisión consensuada). Una de las barreras más importantes para la aplicación del proceso de decisión compartida en salud mental es la cuestión de la capacidad del enfermo mental. Por ello, la evaluación de la capacidad debe hacerse central en la práctica clínica psiquiátrica.

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