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

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

Research output: Contribution to journalArticlepeer-review

Abstract

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 >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.
Original languageEnglish
JournalThe British Journal of Psychiatry
Early online date20 May 2016
Publication statusE-pub ahead of print - 20 May 2016

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