Clinical decision making in psychiatry by psychiatrists

OBJECTIVE: To derive an in-depth understanding of the decision-making process in psychiatry and to explore similarities and differences in psychiatrists' decision-making process and the factors that may influence psychiatrists' decisions. METHOD: A total of 31 psychiatrists were interviewed on their approaches to decision making in psychiatric practice, using a semistructured interview guide. Framework analysis was undertaken to derive a qualitative understanding of decision making in psychiatry. RESULTS: The analysis generated seven main themes, which collectively influenced the decision-making process in psychiatry: information gathering, training in psychiatry, intuition and experience, evidence-based practice, cognitive reasoning, uncontrollable factors and multidisciplinary team influences. CONCLUSION: No single approach to decision making emerged from the analysis. Approaches to decision making were influenced by the level of clinical experience and external pressures, such as time and treatment availability. Findings were consistent with dual-processing theory of decision making.