Digital Shared Decision-Making Interventions in Mental Healthcare: A Systematic Review and Meta-Analysis

Abstract

Background: Shared decision-making (SDM) in mental healthcare has received increased attention as a process to reinforce person-centered care. With the rapid development of digital health technology, researchers investigate how digital interventions may be utilized to support SDM. Despite the promise of digital interventions to support SDM, the effect of these in mental healthcare has not been evaluated before. Thus, this paper aims to assess the effect of SDM interventions complimented by digital technology in mental healthcare.Objective: The objective of this review was to systematically examine the effectiveness of digital SDM interventions on patient outcomes as investigated in randomized trials.Methods: We performed a systematic review and meta-analysis of randomized controlled trials on digital SDM interventions for people with a mental health condition. We searched for relevant studies in MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. The search strategy included terms relating to SDM, digital systems, mental health conditions, and study type. The primary outcome was patient activation or indices of the same (e.g., empowerment and self-efficacy), adherence to treatment, hospital admissions, severity of symptoms, and level of functioning. Secondary outcomes were satisfaction, decisional conflict, working alliance, usage, and adherence of medicine; and adverse events were defined as harms or side effects.Results: Sixteen studies met the inclusion criteria with outcome data from 2,400 participants. Digital SDM interventions had a moderate positive effect as compared with a control condition on patient activation [standardized mean difference (SMD) = 0.56, CI: 0.10, 1.01, p = 0.02], a small effect on general symptoms (SMD = −0.17, CI: −0.31, −0.03, p = 0.02), and working alliance (SMD = 0.21, CI: 0.02, 0.41, p = 0.03) and for improving decisional conflict (SMD = −0.37, CI: −0.70, −0.05, p = 0.02). No effect was found on self-efficacy, other types of mental health symptoms, adverse events, or patient satisfaction. A total of 39 outcomes were narratively synthesized with results either favoring the intervention group or showing no significant differences between groups. Studies were generally assessed to have unclear or high risk of bias, and outcomes had a Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of low- or very low-quality evidence.Conclusions: Digital interventions to support SDM may be a promising tool in mental healthcare; but with the limited quality of research, we have little confidence in the estimates of effect. More quality research is needed to further assess the effectiveness of digital means to support SDM but also to determine which digital intervention features are most effective to support SDM.Systematic Review Registration: PROSPERO, identifier CRD42020148132.

A Smartphone App to Promote Patient Activation and Support Shared Decision-making in People With a Diagnosis of Schizophrenia in Outpatient Treatment Settings (Momentum Trial): Randomized Controlled Assessor-Blinded Trial

“…The study found a statistically significant difference in our primary outcome, patient activation, CHAI-MH (mean difference 4.39, 95% CI 0.99-7.79; Cohen d =0.33; P =.01), favoring the intervention group. These findings confirm our hypothesis that a digital SDM tool may promote patient activation by supporting the collaborative process between patients and their providers and is in concordance with recent meta-analyses on the effectiveness of digital SDM interventions that found these types of interventions to have an effect on patient activation [ 11 ]. The effect size (Cohen d ) for patient activation was 0.33, which may be interpreted as a small effect size.…”

“…Digital mental health interventions, such as interventions including a smartphone app, have been found to significantly outperform control groups [ 10 ]. However, the evidence on digital mental health interventions to support SDM is sparse, but a recent meta-analysis found that digital SDM interventions may have an effect on patient activation, decisional conflict, working alliance, and severity of general symptoms [ 11 ]. The meta-analysis also concluded that while digital interventions to support SDM are promising, the limited evidence is in need for quality research.…”

Trends, challenges, and priorities for shared decision making in mental health: The first umbrella review

“…After the duplicate removal and screening of titles and abstracts, 25 full-text reviews were assessed for eligibility through full-text screening. After this assessment, 10 systematic reviews ( Broughton et al, 2021 ; Duncan et al, 2010 ; Fiorillo et al, 2020 ; Fisher et al, 2021 ; Légaré et al, 2018 ; Samalin et al, 2018 ; Stacey et al, 2017 ; Thomas et al, 2021 ; Vitger et al, 2021 ; Zisman-Ilani, Barnett et al, 2017 ) met the inclusion criteria ( Figure 1 ). All 10 reviews evaluated SDM interventions and/or tools for dyadic patient-clinician psychopharmacological decision-making and included various mental health conditions, SDM intervention types and outcomes.…”

“…All reviews referred to the broader SDM literature and cited at least one of the following SDM models: Charles et al model of medical decision-making ( Duncan et al, 2010 ; Fisher et al, 2021 ; Légaré et al, 2018 ; Stacey et al, 2017 ; Thomas et al, 2021 ; Vitger et al, 2021 ; Zisman-Ilani, Barnett et al, 2017 ), the Integrative model of SDM ( Stacey et al, 2017 ), the Three Talk Model ( Broughton et al, 2021 ; Fiorillo et al, 2020 ; Légaré et al, 2018 ; Samalin et al, 2018 ; Vitger et al, 2021 ; Zisman-Ilani, Barnett et al, 2017 ), the SDM 3 Circle model ( Légaré et al, 2018 ; Vitger et al, 2021 ). However, not all reviews ( k = 9/10) included a definition of SDM ( Duncan et al, 2010 ; Fiorillo et al, 2020 ; Fisher et al, 2021 ; Légaré et al, 2018 ; Samalin et al, 2018 ; Stacey et al, 2017 ; Thomas et al, 2021 ; Vitger et al, 2021 ; Zisman-Ilani, Barnett et al, 2017 ).…”

Survey research of patient’s preference on choosing microscopic or endoscopic spine surgery for lumbar discectomy

“…Shared decision-making has received increased attention as a process to reinforce patient-centered care [ 15 ], and has been used in various diseases such as oncology and neonatology medicine [ 16 , 17 ]. It should be considered when controversial treatment divided clinicians’ opinion and the different treatments impact on the patient outcomes.…”