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

ABSTRACT

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.