Psychology ETDs

Publication Date

Summer 5-12-2019


Shared Decision-Making (SDM) is being increasingly advocated for in the fields of physical and mental healthcare as it provides a means for patients and providers to engage in meaningful conversation about treatment decisions. Although there are many reasons for advocating for the implementation of SDM, there is limited information on how SDM impacts patient outcomes throughout treatment and the mechanisms through which these effects occur, and this information is even more limited in the area of mental health. The current research used secondary data analyses to examine patient and provider perspectives on the occurrence of SDM and patient engagement in treatment decisions over a year study and how they influence changes in mental/physical health and well-being. The research aimed to determine: (1) the extent to which patients and providers agreed about SDM and engagement; (2) whether patient decision satisfaction and perceptions of working alliance mediated the relationship between perceived communication and health outcomes; (3) if certain patient demographics were associated with increased preference for engagement in treatment decisions; and (4) what factors mediated the relationship between patient-provider communication and outcomes. The results suggested patient-provider agreement about communication was generally high and that patients tended to perceive better communication than providers. However, when disagreement was greater, providers tended to perceive better communication than patients. Mediational effects were unsupported by the data, but there are positive associations between perceived SDM/patient engagement and better patient outcomes, decision satisfaction, and working alliance. Younger individuals and females reported greater preference for being engaged in treatment decisions, and preference did not significantly vary race/ethnicity. Finally, age, gender, and continuity of care moderated the relationship between patient perceptions of communication and decision satisfaction/working alliance. Specifically, for those who are younger, female, and who have provider turnover, perceptions of communication have a larger impact on decision satisfaction/working alliance. Although mediation was not supported, findings do suggest that providers should be aware of how communication styles impact outcomes, particularly for women, younger individuals, and individuals who have inconsistent providers. Other implications, limitations, and future directions are discussed.

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Level of Degree


Department Name


First Committee Member (Chair)

Dr. Bruce Smith

Second Committee Member

Dr. Alya Reeve

Third Committee Member

Dr. Katie Witkiewitz

Fourth Committee Member

Dr. Jessica Goodkind




shared decision-making, community mental health, patient-provider agreement, well-being

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Included in

Psychology Commons