Shared decision-making interventions for people with mental health conditions
- PMID: 36367232
- PMCID: PMC9650912
- DOI: 10.1002/14651858.CD007297.pub3
Shared decision-making interventions for people with mental health conditions
Abstract
Background: One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010.
Objectives: To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes.
Search methods: We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification.
Selection criteria: Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria).
Data collection and analysis: We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence.
Main results: This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported.
Authors' conclusions: This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Conflict of interest statement
YA: co‐authorship of the included study Aoki 2019a YY: none declared TU: has received lecture fees from Eisai. YT: has received lecture fees from Otsuka Pharmaceutical, Meiji Seika Pharma, Eli Lilly, Eisai, Mitsubishi Tanabe Pharma, MSD, and Yoshitomi Pharmaceutical, and has received research funding from Otsuka Pharmaceutical, Meiji Seika Pharma, MSD, and Eisai; and co‐authorship of the included study Aoki 2019a. NW: has received royalties from Sogensha, Medical Review, and Akatsuki for writings. KW: has received manuscript fees or speaker’s honoraria from Daiichi Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Yoshitomi, and has received research/grant support from Astellas Pharma, Daiichi Sankyo, Eisai, MSD, Mitsubishi Tanabe Pharma, Meiji Seika Pharma, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, and is a consultant of Eisai, Eli Lilly, Kyowa Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda Pharmaceutical; and co‐authorship of the included study Aoki 2019a. ED: none declared LS: none declared MS: none declared AE: none declared
Those members of the review author team who co‐authored the included study Aoki 2019a did not select, extract data, or appraise the risk of bias for this study. GRADE ratings for the assessment of the overall certainty of the evidence for each outcome were led by review authors other than YA, TY, and KW (authors on the Aoki 2019a trial).
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Update of
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Shared decision making interventions for people with mental health conditions.Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD007297. doi: 10.1002/14651858.CD007297.pub2. Cochrane Database Syst Rev. 2010. Update in: Cochrane Database Syst Rev. 2022 Nov 11;11:CD007297. doi: 10.1002/14651858.CD007297.pub3. PMID: 20091628 Free PMC article. Updated.
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Finnerty 2019 {published data only}
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- Finnerty M, Austin E, Chen Q, Layman D, Kealey E, Ng-Mak D, et al. Implementation and use of a client-facing web-based shared decision-making system (MyCHOIS-CommonGround) in two specialty mental health clinics. Community Mental Health Journal 2019;55(4):641-50. [DOI: 10.1007/s10597-018-0341-x] [PMID: ] - DOI - PMC - PubMed
Fisher 2018 {published data only}
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- Fisher A, Sharpe L, Anderson J, Manicavasagar V, Juraskova I. Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse. PLoS One 2018;13(7):e0200490. [DOI: 10.1371/journal.pone.0200490] [PMID: ] - DOI - PMC - PubMed
Fisher 2020 {published data only}
Flückiger 2012 {published data only}
Fortney 2010 {published data only}
Furukawa 2018 {published data only}
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- Furukawa TA, Efthimiou O, Weitz ES, Cipriani A, Keller MB, Kocsis JH, et al. Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: personalizing the treatment choice using individual participant data network metaregression. Psychotherapy and Psychosomatics 2018;87(3):140-53. [DOI: 10.1159/000489227] [PMID: ] - DOI - PubMed
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Gioia 2014 {published data only}
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- Gioia D, Autrey S, Drapalski AL, Glynn S, Cohen AN, Dixon LB. Veterans' views of a shared decision-making process: a qualitative substudy of REORDER. American Journal of Psychiatric Rehabilitation 2014;17(4):348‐64 .
Glick 2011 {published data only}
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- Glick ID, Correll CU, Altamura AC, Marder SR, Csernansky JG, Weiden PJ, et al. Mid-term and long-term efficacy and effectiveness of antipsychotic medications for schizophrenia: a data-driven, personalized clinical approach. Journal of Clinical Psychiatry 2011;72(12):1616-27. [DOI: 10.4088/JCP.11r06927] [PMID: ] - DOI - PubMed
Goff 2010 {published data only}
Goulding 2018 {published data only}
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- Goulding A, Allerby K, Ali L, Waern M. Person-centered psychosis care (PCPC) in an inpatient setting: patient outcomes. Schizophrenia Bulletin 2018;44(Suppl 1):S426.
Gray 2010 {published data only}
Grootens 2019 {published data only}
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- Grootens KP, Van Thiel V, Hartong E. 'How harmful is your mania to you or others?' Sharing decisions about antidepressant treatment in bipolar depression. Tijdschrift Voor Psychiatrie 2019;61(2):78-80 . - PubMed
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Gunlicks‐Stoessel 2016 {published data only}
Gvirts 2018 {published data only}
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- Gvirts HZ, Lewis YD, Dvora S, Feffer K, Nitzan U, Carmel Z, et al. The effect of methylphenidate on decision making in patients with borderline personality disorder and attention-deficit/hyperactivity disorder. International Clinical Psychopharmacology 2018;33(4):233-7. [DOI: 10.1097/YIC.0000000000000219] [PMID: ] - DOI - PubMed
Hahn 2009 {published data only}
Hamann 2014 {published data only}
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- Hamann J, Maris N, Iosifidou P, Mendel R, Cohen R, Wolf P, et al. Effects of a question prompt sheet on active patient behaviour: a randomized controlled trial with depressed outpatients. International Journal of Social Psychiatry 2014;60(3):227-35. [DOI: 10.1177/0020764013482311] [PMID: ] - DOI - PubMed
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Hayes 2019 {published data only}
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- Hayes D, Edbrooke-Childs J, Town R, Wolpert M, Midgley N. Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework. European Child & Adolescent Psychiatry 2019;28(5):655-66. [DOI: 10.1007/s00787-018-1230-0] [PMID: ] - DOI - PMC - PubMed
He 2016 {published data only}
Hell 2021 {published data only}
Henderson 2013 {published data only}
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- Henderson C, Brohan E, Clement S, Williams P, Lassman F, Schauman O, et al. Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial. British Journal of Psychiatry 2013;203(5):350-7. [DOI: 10.1192/bjp.bp.113.128470] [PMID: ] - DOI - PubMed
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- Henderson C. Planning ahead for acute mental health crises: methods and outcomes. European Psychiatry 2018;48(Suppl):S71.
Heres 2012 {published data only}
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- Heres S. What are the clinical implications of long-acting antipsychotics for psychiatrists? European Neuropsychopharmacology 2012;22(Suppl 2):S449.
Hessinger 2018 {published data only}
Hoffman 2014 {published data only}
Hohl‐Radke 2018 {published data only}
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- Hohl-Radke F, Enzmann A, Kaiser W. Therapy satisfaction in establishing a modular system to amend therapy for patients in psychosis. Swiss Archives of Neurology, Psychiatry and Psychotherapy 2018;169(5):151-5.
Holzhüter 2020 {published data only}
Hopp 2011 {published data only}
Howard 2009 {published data only}
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- Howard L, Flach C, Leese M, Byford S, Killaspy H, Cole L, et al . Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial. British Journal of Psychiatry. Supplement 2010;53:s32-40. [DOI: 10.1192/bjp.bp.110.081083] [PMID: ] - DOI - PubMed
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Hsu 2013 {published data only}
Huijbregts 2013 {published data only}
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- Huijbregts KM, De Jong FJ, Van Marwijk HW, Beekman AT, Adèr HJ, Hakkaart-van Roijen L, et al. A target-driven collaborative care model for Major Depressive Disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative. Journal of Affective Disorders 2013;146(3):328-37. [DOI: 10.1016/j.jad.2012.09.015] [PMID: ] - DOI - PubMed
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ISRCTN11230559 {published data only}
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- ISRCTN11230559. Decision aid for young people who self-harm (DASH). www.isrctn.com/ISRCTN11230559 (first received 22 May 2015).
ISRCTN14184328 {published data only}
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- ISRCTN14184328. Ready for SDM - evaluation of a multidisciplinary training module in shared decision making. www.isrctn.com/ISRCTN14184328 (first received 9 May 2018).
ISRCTN16140131 {published data only}
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- ISRCTN16140131. Testing an implementation strategy to help primary care providers provide mental health medications for veterans with PTSD (PROMPT trial). doi.org/10.1186/ISRCTN16140131 (first received 6 March 2019).
ISRCTN38536761 {published data only}
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- ISRCTN38536761. Counselling parents in youth mental health care: a design for structured communication of diagnosis and treatment options. www.isrctn.com/ISRCTN38536761 (first received 11 May 2011).
ISRCTN51103766 {published data only}
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- ISRCTN51103766. A web-based tool to support shared decision making between clinicians and patients in routine outcome monitoring. www.isrctn.com/ISRCTN51103766 (first received 8 August 2013).
Johnson 2012 {published data only}
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- Johnson JR, Engelberg RA, Downey L, Cooke CR, Nielsen EL, Treece PD, et al. Trust in physicians predicts family members' preferred role in decision-making in ICUs. American Journal of Respiratory and Critical Care Medicine 2012;185:A5208.
Joosten 2009 {published data only}
Joosten 2011a {published data only}
Joosten 2011b {published data only}
Jørgensen 2014 {published data only}
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- Jørgensen R, Licht RW, Lysaker PH, Munk-Jørgensen P, Buck KD, Jensen SO, et al. Effects on cognitive and clinical insight with the use of guided self-determination in outpatients with schizophrenia: a randomized open trial. European Psychiatry 2015;30(5):655-63. [DOI: 10.1016/j.eurpsy.2014.12.007] [PMID: ] - DOI - PubMed
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- Jørgensen R, Munk-Jørgensen P, Lysaker PH, Buck KD, Hansson L, Zoffmann V. Overcoming recruitment barriers revealed high readiness to participate and low dropout rate among people with schizophrenia in a randomized controlled trial testing the effect of a guided self-determination intervention. BMC Psychiatry 2014;14:28. [DOI: 10.1186/1471-244X-14-28] [PMID: ] - DOI - PMC - PubMed
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- Kageyama M, Yokoyama K, Nakamura Y, Kobayashi S, Nishina Y, Oshima I. Factors related to adoption of a family peer-education program on mental disorders. Dissemination research of the Omotenashi-Family Experiences Learning Program. Nihon Koshu Eisei Zasshi 2014;61(10):625-36. [PMID: ] - PubMed
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Katz 2016 {published data only}
Khalifeh 2019 {published data only}
Kroenke 2015 {published data only}
Kwong 2013 {published data only}
Lagomasino 2017 {published data only}
Lara‐Cabrera 2016 {published data only}
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- Lara-Cabrera ML, Gjerden M, Gråwe RW, Linaker OM, Steinsbekk, A. Short-term effects of a peer co-led educational programme delivered before mental health treatment: a randomised controlled trial. Patient education and counseling 2016;99(7):1257‐61. - PubMed
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- Le QA, Doctor JN, Zoellner LA, Feeny NC. Cost-effectiveness of prolonged exposure therapy versus pharmacotherapy and treatment choice in posttraumatic stress disorder (the Optimizing PTSD Treatment Trial): a doubly randomized preference trial. Journal of Clinical Psychiatry 2014;75(3):222-30. [DOI: 10.4088/JCP.13m08719] [PMID: ] - DOI - PubMed
Lee 2015 {published data only}
Liverpool 2021a {published data only}
Lokman 2017 {published data only}
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- Lokman S, Volker D, Zijlstra-Vlasveld M, Smit F, Van Der Feltz-Cornelis C. Return-to-work intervention versus care as usual for sick listed employees with common mental disorders: trial-based economic evaluation shows promise. In: Journal of mental health policy and economics. Vol. 18. 2015:S26‐S27.
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Lord 2017 {published data only}
Lutz 2022 {published data only}
MacInnes 2013 {published data only}
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- MacInnes D, Kinane C, Beer D, Parrott J, Craig T, Eldridge S, et al. Study to assess the effect of a structured communication approach on quality of life in secure mental health settings (Comquol): study protocol for a pilot cluster randomized trial. Trials 2013;14:257. [DOI: 10.1186/1745-6215-14-257] [PMID: ] - DOI - PMC - PubMed
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Maj 2021 {published data only}
Malloy‐Weir 2017 {published data only}
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- Malloy-Weir LJ, Kirk A. Development and pilot testing of a decision aid for the initiation of antipsychotic medications in persons with dementia in long-term care using a systematic approach: a study protocol. BMJ Open 2017;7(10):e018769. [DOI: 10.1136/bmjopen-2017-018769] [PMID: ] - DOI - PMC - PubMed
Marshall 2013 {published data only}
Metz 2018 {published data only}
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- Metz M, Elfeddali I, Veerbeek M, De Beurs E, Beekman A, Van der Feltz-Cornelis C. Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in shared decision making: a cluster randomised controlled trial in a specialist mental health outpatient setting. PLoS One 2018;13(6):e0199795. [DOI: 10.1371/journal.pone.0199795] [PMID: ] - DOI - PMC - PubMed
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- Metz MJ, Franx GC, Veerbeek MA, De Beurs E, Van der Feltz-Cornelis CM, Beekman AT. Shared Decision Making in mental health care using Routine Outcome Monitoring as a source of information: a cluster randomised controlled trial. BMC Psychiatry 2015;15:313. [DOI: 10.1186/s12888-015-0696-2] [PMID: ] - DOI - PMC - PubMed
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- Metz MJ, Veerbeek MA, Elfeddali I, De Beurs E, Van der Feltz-Cornelis CM, Beekman AT. Shared decision making in mental health care; evaluation of the added value for patients and clinicians [Samen beslissen in de ggz; onderzoek naar toegevoegde waarde voor patiënten en behandelaars]. Tijdschrift voor Psychiatrie 2019;61(7):487-97. - PubMed
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- NTR5262. Shared decision making in mental health with routine outcome monitoring (ROM) as an information source. trialsearch.who.int/Trial2.aspx?TrialID=NTR5262 (first received 24 June 2015).
Moncrieff 2016 {published data only}
Mooney 2020 {published data only}
Mort 2013 {published data only}
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- Mort JR. Involving the resident/decision maker in antipsychotic medication use. South Dakota Medicine 2013;66(4):148-9. [PMID: ] - PubMed
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NCT02364544 {published data only}
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- NCT02364544. Improving care and reducing cost study. clinicaltrials.gov/show/NCT02364544 (first received 18 February 2015).
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- NCT02507349. Person-centered versus measurement-based care in mental health (PCORI-SDM). clinicaltrials.gov/ct2/show/NCT02507349 (first received 23 July 2015).
NCT02989805 {published data only}
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- NCT02989805. Engaging patients with mental disorders from the ED in outpatient care. clinicaltrials.gov/show/NCT02989805 (first received 12 December 2016).
NCT03070977 {published data only}
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- NCT03070977. Interprofessional training in a psychiatric study unit. clinicaltrials.gov/ct2/show/NCT03070977 (first received 6 March 2017).
NCT03258632 {published data only}
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- NCT03258632. Improving outcomes among medical/surgical inpatients with alcohol use disorders. clinicaltrials.gov/show/NCT03258632 (first received 23 August 2017).
NCT03539068 {published data only}
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- NCT03539068. Online and shared decision-making interventions to engage service men and women in post-deployment mental health care. clinicaltrials.gov/show/NCT03539068 (first received 29 May 2018).
NCT03869177 {published data only}
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- NCT03869177. Implementation of family involvement for persons with psychotic disorders. (IFIP). clinicaltrials.gov/ct2/show/NCT03869177 (first received 11 March 2019).
NCT04562038 {published data only}
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- NCT04562038. Implementation of electronic shared decision-making support for early intervention. clinicaltrials.gov/show/NCT04562038 (first received 24 September 2020).
NCT04593472 {published data only}
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- NCT04593472. SHARE: Sharing Healthcare Wishes in Primary Care. clinicaltrials.gov/ct2/show/NCT04593472 (first received 20 October 2020).
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- SHARE: sharing healthcare wishes in primary care. trialbulletin.com/lib/entry/ct-04593472.
NCT04601194 {published data only}
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- Goal Elicitation, Treatment Prioritization, & Electronically-Practiced Discussion for Psychiatry. trialbulletin.com/lib/entry/ct-04601194.
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- NCT04601194. Goal Elicitation, Treatment Prioritization, & Electronically-Practiced Discussion for Psychiatry (GET-PrEPD). clinicaltrials.gov/ct2/show/NCT04601194 (first received 23 October 2020).
NCT05156073 {published data only}
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- Shared Decision Making About Medication Use for People With Multiple Health Problems. clinicaltrials.gov/ct2/show/NCT05156073 (first received 14 December 2021).
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- Shared decision making about medication use for people with multiple health problems. trialbulletin.com/lib/entry/ct-05156073.
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- Nieboer AP, Cramm JM, Van der Meij B, Huijsman R. Choice processes and satisfaction with care according to parents of children and young adults with intellectual disability in the Netherlands. Journal of Intellectual & Developmental Disability 2011;36(2):127-36. [DOI: ] [PMID: ] - PubMed
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- NTR5773. Bringing palliative care for dementia patients into agreement with their wishes and needs: development and evaluation of Decidem. trialsearch.who.int/Trial2.aspx?TrialID=NTR5773 (first received 1 January 2016).
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Nuss 2018 {published data only}
Pachoud 2015 {published data only}
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- Pachoud B, Llorca PM, Salmona I, Trabut JB. Shared decision making in psychiatric: what use? European Psychiatry 2015;30(8 Suppl):S39.
Park 2020 {published data only}
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