Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions

Zisman‐Ilani, Yaara; Barnett, Erin R.; Harik, Juliette M.; Pavlo, Anthony J.; O’Connell, Maria

doi:10.1108/mhrj-01-2017-0002

Cited by 76 publications

(90 citation statements)

References 74 publications

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“…This innovative DA addresses numerous unmet decisional-support needs identified by patients with BPII and their family [ 15 ], and adds to the relative paucity of evidence-based interventions for promoting SDM in mental health [ 76 , 77 ]. Supporting the pilot aims, the DA was highly acceptable among potential end-users, and was feasible and safe to deliver to newly-diagnosed patients who are considering their treatment options to prevent relapse.…”

Section: Discussionmentioning

confidence: 99%

Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse

et al. 2018

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IntroductionTreatment decisions in bipolar II disorder (BPII) are finely-balanced and sensitive to patient preferences. This pilot study evaluated a decision-aid booklet (DA) for patients with BPII (and their family) to obtain evidence on its acceptability, feasibility, safety, and usefulness in potential end-users.MethodsThe DA booklet was developed according to International Patient Decision-Aid Standards. Thirty-one patients diagnosed with BPII and their families (n = 11), who were currently making or had previously made treatment decisions, participated. Participants read the DA and completed validated and purpose-designed questionnaires. A follow-up semi-structured telephone interview elicited more in-depth DA feedback (n = 40).ResultsPatients and family endorsed the DA booklet as: easy-to-use (100% agree), useful in treatment decision-making (100%), presenting balanced (patients = 96.8%, family = 100%), up-to-date (93.5%, 100%) and trustworthy information (93.5%, 100%) that did not provoke anxiety (93.5%, 90.9%). All participants stated that they would recommend the DA to others. Following DA use, all except one participant (97.6%) demonstrated adequate treatment knowledge (> 50% score). Patients reported low decisional conflict (M = 18.90/100) following DA use and felt well-prepared to make treatment decisions (M = 4.28/5). Most patients (90.3%) indicated uptake of treatments consistent with the best available clinical evidence. Additionally, a large proportion of patients made an informed choice about medication (65.5%) with adjunctive psychological treatment (50.0%), based on adequate knowledge and their treatment values. Interview findings further supported the DA’s acceptability among participants.DiscussionPilot findings indicate that patients with BPII and their family consider this DA booklet highly acceptable and useful in making evidence-based treatment decisions that align with their treatment preferences.

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Section: Discussionmentioning

confidence: 99%

Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse

et al. 2018

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“…Decision aids (DAs) are tools used to provide balanced information on treatments, clarify patient values and facilitate patient engagement in decision-making. In a recent systematic review of DAs in health settings in general12 and in mental health settings specifically,13 DAs were found to increase knowledge, improve alignment of treatment with patient preferences, increase patient satisfaction and reduce decisional conflict. In addition, DAs designed for use during the clinic visit, encounter-based DAs (eDAs), are associated with increased SDM 12.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Options for People Experiencing Depression (HOPE*D): the development and pilot testing of an encounter-based decision aid for use in primary care

et al. 2019

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ObjectiveTo develop and pilot an encounter-based decision aid (eDA) for people with depression for use in primary care.DesignWe developed an eDA for depression through cognitive interviews and pilot tested it using a one-group pretest, post-test design in primary care. Feasibility, fidelity of eDA use and acceptability were assessed using recruitment rates and semistructured interviews with patients, medical assistants and clinicians. Treatment choice and shared decision-making (SDM) were also assessed.SettingInterviews with adult patients and the public were conducted in a mall and library in Grafton County, New Hampshire, while clinician interviews took place by phone or at the clinician’s office. Pilot testing occurred in a New Hampshire primary care practice.ParticipantsCognitive interviews were conducted with adults, ≥18 years, who could read English from the following stakeholder groups: history of depression, the public and clinicians. Patients with a Patient Health Questionnaire-9 score of ≥5 were recruited for piloting.ResultsThree stages of cognitive interviews were conducted (n=28). Changes to eDA included moving the combination therapy information and access to treatment information, adding colour, modifying pictograms and editing the talk-therapy description. Clinician concerns about patient health literacy were not reflected in patient interviews. Of 59 patients who reviewed study information, 56 were eligible and agreed to participate in pilot testing; however, only 29 could be reached for follow-up. The eDA was widely accepted, though clinicians did not always use it as intended. We found no impact of eDA use on SDM, though patients chose a wider range of treatment options.ConclusionsWe demonstrated the feasibility of the use of an eDA for depression in primary care that was widely accepted. Further research is needed to improve the fidelity with which the eDA is used and to assess its impact on SDM and related health outcomes.

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“…It should be acknowledged that although patient DAs are designed to facilitate SDM, the provision of patient DAs in and of themselves does not guarantee that SDM occurs. Rather, SDM is complex and expansive process, especially in mental health [ 42 , 43 ]. Therefore patient DAs should be regarded as a tool as part of suite of multicomponent interventions that can be used to encourage SDM [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rather, SDM is complex and expansive process, especially in mental health [ 42 , 43 ]. Therefore patient DAs should be regarded as a tool as part of suite of multicomponent interventions that can be used to encourage SDM [ 43 ]. It cannot be ascertained from the current trial whether the patient decision-aid was efficacious at improving SDM per se, however, it did lead to improved outcomes in both decision-making quality (e.g., decisional conflict) and quality of the decision made (e.g., treatment knowledge).…”

Section: Discussionmentioning

confidence: 99%

Improving treatment decision-making in bipolar II disorder: a phase II randomised controlled trial of an online patient decision-aid

et al. 2020

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Background Many patients with bipolar II disorder (BPII) prefer to be more informed and involved in their treatment decision-making than they currently are. Limited knowledge and involvement in one’s treatment is also likely to compromise optimal BPII management. This Phase II RCT aimed to evaluate the acceptability, feasibility, and safety of a world-first patient decision-aid website (e-DA) to improve treatment decision-making regarding options for relapse prevention in BPII. The e-DA’s potential efficacy in terms of improving quality of the decision-making process and quality of the decision made was also explored. Methods The e-DA was based on International Patient Decision-Aid Standards and developed via an iterative co-design process. Adults with BPII diagnosis (n = 352) were recruited through a specialist outpatient clinical service and the social media of leading mental health organisations. Participants were randomised (1:1) to receive standard information with/without the e-DA (Intervention versus Control). At baseline (T0), post-treatment decision (T1) and at 3 months’ post-decision follow-up (T2), participants completed a series of validated and purpose-designed questionnaires. Self-report and analytics data assessed the acceptability (e.g., perceived ease-of-use, usefulness; completed by Intervention participants only), safety (i.e., self-reported bipolar and/or anxiety symptoms), and feasibility of using the e-DA (% accessed). For all participants, questionnaires assessed constructs related to quality of the decision-making process (e.g., decisional conflict) and quality of the decision made (e.g., knowledge of treatment options and outcomes). Results Intervention participants endorsed the e-DA as acceptable and feasible to use (82.1–94.6% item agreement); most self-reported using the e-DA either selectively (51.8%; relevant sections only) or thoroughly (34%). Exploratory analyses indicated the e-DA’s potential efficacy to improve decision-making quality; most between-group standardised mean differences (SMD) were small-to-moderate. The largest potential effects were detected for objective treatment knowledge (− 0.69, 95% CIs − 1.04, − 0.33 at T1; and − 0.57, 95% CIs − 0.99,-0.14 at T2), decisional regret at T2 (0.42, 95% CIs 0.01, 0.84), preparation for decision-making at T1 (− 0.44, 95% CIs − 0.81, − 0.07), and the Decisional Conflict Scale Uncertainty subscale (0.42, 95% CIs 0.08, 0.08) and Total (0.36, 95% CIs 0.30, 0.69) scores, with all SMDs favouring the Intervention over the Control conditions. Regarding safety, e-DA use was not associated with worse bipolar symptoms or anxiety. Conclusion The e-DA appears to be acceptable, feasible, safe and potentially efficacious at improving patients’ decision-making about BPII treatment. Findings also support the future adoption of the e-DA into patient care for BPII to foster treatment decisions based on the best available evidence and patient preferences. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000840381 (prospectively registered 07/06/2017).

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Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions

Cited by 76 publications

References 74 publications

Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse

Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse

Healthcare Options for People Experiencing Depression (HOPE*D): the development and pilot testing of an encounter-based decision aid for use in primary care

Improving treatment decision-making in bipolar II disorder: a phase II randomised controlled trial of an online patient decision-aid

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