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Randomized Controlled Trial
. 2018 Aug 22;13(8):e0201533.
doi: 10.1371/journal.pone.0201533. eCollection 2018.

Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

Karina Lovell  1   2 , Penny Bee  1 , Helen Brooks  3 , Patrick Cahoon  2 , Patrick Callaghan  4 , Lesley-Anne Carter  5 , Lindsey Cree  1 , Linda Davies  5 , Richard Drake  6 , Claire Fraser  1 , Chris Gibbons  7 , Andrew Grundy  8 , Kathryn Hinsliff-Smith  8 , Oonagh Meade  9 , Chris Roberts  5 , Anne Rogers  10 , Kelly Rushton  1 , Caroline Sanders  5 , Gemma Shields  5 , Lauren Walker  1 , Peter Bower  5
Affiliations
Randomized Controlled Trial

Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

Karina Lovell et al. PLoS One. .

Abstract

Background: Severe mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning.

Methods: We cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of 'autonomy support'. Primary and secondary outcomes were collected by self-report, six months after allocation.

Findings: In total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome.

Conclusions: An intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Consolidated standards of reporting trials (CONSORT) for cluster and cross sectional cohorts.
Fig 2
Fig 2. Cluster design.
Fig 3
Fig 3. Intervention components according to the TIDieR guidelines.
See this image and copyright information in PMC

References

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