Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis

Stovell, Diana; Morrison, Anthony P.; Panayiotou, Margarita; Hutton, Paul

Abstract

BACKGROUND:
In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services 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 people with psychosis.

METHOD:
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning 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 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09-0.51), although the effect was smaller if trials with >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 effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was 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.

Citation

Stovell, D., Morrison, A. P., Panayiotou, M., & Hutton, P. (2016). Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis. British Journal of Psychiatry, 209(1), 23-28. https://doi.org/10.1192/bjp.bp.114.158931

• Journal Article Type: Article
• Acceptance Date: Aug 15, 2015
• Online Publication Date: Jan 2, 2018
• Publication Date: 2016-07
• Deposit Date: Dec 15, 2016
• Publicly Available Date: Aug 1, 2017
• Journal: British Journal of Psychiatry
• Print ISSN: 0007-1250
• Electronic ISSN: 1472-1465
• Publisher: Royal College of Psychiatrists
• Peer Reviewed: Peer Reviewed
• Volume: 209
• Issue: 1
• Pages: 23-28
• DOI: https://doi.org/10.1192/bjp.bp.114.158931
• Keywords: Schizophrenia, shared-decision making, patient empowerment, psychosis,
• Public URL: http://researchrepository.napier.ac.uk/Output/454736
• Contract Date: Feb 15, 2017