Hutton, Paul

Morrison, Anthony P

Panayiotou, Margarita

Stovell, Diana

English

Background: In the UK, almost 60% of service users diagnosed with schizophrenia say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.Aims: To examine the effects of shared decision-making on indices of treatment-related empowerment of service users with psychosis.Method: We conducted a systematic review and meta-analysis of randomised controlled trials of shared decision-making for current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.Results: We identified 11 randomised controlled trials. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09 to 0.51), although the effect was smaller if trials with &gt;25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15-18 months (3 RCTs; RR 0.59, 95% CI 0.35, 1.02), with a number needed to treat of approximately 10 (95% CI 5, ∞). No clear effects on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) were found, but data were heterogeneous.Conclusions: For people with psychosis, the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required.<br/

Edinburgh Research Explorer

The effect of shared decision-making on empowerment-related outcomes in psychosis: a systematic review and meta-analysis

https://www.pure.ed.ac.uk/ws/files/22024933/SDM_in_psychosis_BJP_submission.pdf

The effect of shared decision-making on empowerment-related outcomes in psychosis: a systematic review and meta-analysis

Abstract

Similar works

Full text

Available Versions

Edinburgh Research Explorer