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Systematic review and meta-analysis of factors that help or hinder treatment decision-making capacity in psychosis

Larkin, Amanda; Hutton, Paul

Authors

Amanda Larkin



Abstract

Background: The evidence on factors that may influence treatment decisional capacity (‘capacity) in psychosis has yet to be comprehensively synthesised, which limits the development of effective strategies to improve or support it.
Aims: To determine the direction, magnitude and reliability of the relationship between capacity in psychosis and a range of clinical, demographic and treatment related factors, thus providing a thorough synthesis of current knowledge.
Method: We did a systematic review, meta-analytical and narrative synthesis of factors that help or hinder treatment decision-making capacity in psychosis (PROSPERO registration CRD42015025568), assessing the direction, magnitude, significance and reliability of reported associations.
Results: We identified 23 relevant studies (N=1823). Psychotic symptoms had small, moderate and strong associations with appreciation, understanding, and reasoning, respectively. Both verbal cognitive functioning and duration of education had small to moderate correlations with understanding and reasoning. Better capacity was also associated with better insight, better metacognitive ability, higher anxiety and lower perceived coercion. No linear relationship with depression was observed. Interventions linked to improved capacity over time were inpatient care (including antipsychotic treatment), information-simplification, shared decision-making and metacognitive training.
Conclusion: This synthesis of over 25 years of research provides a comprehensive assessment of factors that may help or hinder treatment decision-making capacity in psychosis. Although much is known about the role of symptoms and other clinical variables, effective and acceptable psychological interventions to support capacity in this group are lacking.

Citation

Larkin, A., & Hutton, P. (2017). Systematic review and meta-analysis of factors that help or hinder treatment decision-making capacity in psychosis. British Journal of Psychiatry, 211(4), 205-215. https://doi.org/10.1192/bjp.bp.116.193458

Journal Article Type Article
Acceptance Date Feb 14, 2017
Online Publication Date Jan 2, 2018
Publication Date Oct 2, 2017
Deposit Date Feb 15, 2017
Publicly Available Date Mar 28, 2024
Journal British Journal of Psychiatry
Print ISSN 0007-1250
Electronic ISSN 1472-1465
Publisher Royal College of Psychiatrists
Peer Reviewed Peer Reviewed
Volume 211
Issue 4
Pages 205-215
DOI https://doi.org/10.1192/bjp.bp.116.193458
Keywords Treatment decisoins, psychosis, systematic review, decision-making,
Public URL http://researchrepository.napier.ac.uk/Output/685321

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What helps or hinders treatment decision making capacity in psychosis? A systematic review and meta-analysis (541 Kb)
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Copyright Statement
This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at https://doi.org/10.1192/bjp.bp.116.193458


What Helps or hinders treatment decision making capacity in psychosis?...supporting information (56 Kb)
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Copyright Statement
This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at https://doi.org/10.1192/bjp.bp.116.193458


Systematic review and meta-analysis of factors that help or hinder treatment decision-making capacity in psychosis (650 Kb)
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Copyright Statement
This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at https://doi.org/10.1192/bjp.bp.116.193458







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