Feasibility and efficacy of shared decision making for first-admission schizophrenia: a randomized clinical trial

Abstract

BackgroundThe feasibility of shared decision making (SDM) for patients with schizophrenia remains controversial due to the assumed inability of patients to cooperate in treatment decision making. This study evaluated the feasibility and efficacy of SDM in patients upon first admission for schizophrenia.MethodsThis was a randomized, parallel-group, two-arm, open-label, single-center study conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. Patients with the diagnosis of schizophrenia upon their first admission were randomized into a SDM intervention group or a usual treatment group in a 1:1 ratio. The primary outcome was patient satisfaction at discharge. The secondary outcomes were attitudes toward medication at discharge and treatment continuation at 6 months after discharge.ResultsTwenty-four patients were randomly assigned. The trial was prematurely terminated due to slow enrollment. At discharge, the mean score on satisfaction was 23.7 in the SDM group and 22.1 in the usual care group (unadjusted mean difference: 1.6; 95% CI: −5.2 to 2.0). Group differences were not observed in attitude toward medication and treatment continuation. There was no statistically significant difference between the groups for the mean Global Assessment of Functioning score at discharge or length of stay as safety endpoint.ConclusionsNo statistical differences were found between the SDM group and usual care group in the efficacy outcomes and safety endpoints. Large trials are needed to confirm the efficacy of the SDM program upon first admission for schizophrenia.Trial registrationThe study has been registered with ClinicalTrials.gov as NCT01869660 (registered 27 May, 2013).

The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review

“…Training was offered to all psychiatrists and care coordinators who prescribe, monitor or discuss medication with service users Patients reported a change in decisional conflict and perceptions of practitioners’ interactional style in promoting SDM at the follow-up. A positive impact was found on service users’ and care coordinators confidence to explore medication experience, and group-based training was valued Ishii et al (Japan), [ 42 ] Randomized, parallel-group, two-arm, open-label, single-center study N = 24 patients (shared decision making group, N = 11; Usual care group, N = 13); acute psychiatric ward Schizophrenia spectrum disorder according to ICD-10 criteria Patients’ age 16–65 years; no previous psychiatric admission Shared Decision Making group (SDM): 15–20-min weekly intervention provided during the in-patient stay, consisting of three elements: evaluation of patient’s perceptions of on-going treatments; sharing patients’ and medical staffs’ perceptions on the treatments; shared definition of care plan Usual care group: usual psychiatric inpatient care, which mainly include pharmacological treatments Patients in the SDM group reported a higher level of satisfaction towards treatments compared to usual care group, while no differences were found in attitude toward medication, treatment continuation and in the levels of global functioning Hamann et al (Germany), [ 43 ] Randomized-controlled trial, multicenter study N = 264 (intervention group, N = 142; control group, N = 122); acute wards of four participating psychiatric hospitals Schizophrenia, schizoaffective disorder according to ICD-10 criteria Patients’ age 18–60 years Shared Decision Making (SDM): 5-session training (60 min/session) addressing patient competencies for SDM, including sessions on motivational and behavioral aspects (e.g., role plays) and on patient–doctor interaction Control group: 5-session of cognitive training, but with no reference to doctor-patient communication Patients in the SDM group reported an increase in their levels of participation preferences and their wish to take over more responsibility for medical decision. No differences regarding the treatment adherence were found at 6 and 12 months after discharge Finnerty et al (USA), [ 44 ] Multicentre study N = 1416 patients (MyCHOIS–CommonGround, N = 472; control condition, N = 944); 12 Medicaid outpatient clinics Anxiety disorder, bipolar/depressive disorder, post-traumatic stress disorder, schizophrenia spectrum disorder, sleep–wake disorder, substance-related or addictive disorder Adult patients s...…”

“…Ishii et al [ 42 ] developed a training program tailored to patients with schizophrenia during their stay in an acute psychiatric ward. The intervention consists in evaluating the patients’ attitudes on the treatments received, sharing this information with the other clinicians and then identifying a shared plan.…”

Shared decision making for adults with severe mental illness: A concept analysis

“…An inevitable and very real power structure exists between the users and health professionals (Fukui et al, 2014). Mental health services have a history showing that health professionals have been hesitant about patient's active involvement in decision making (Ishii et al, 2017). It is crucial to be aware of hierarchies and disparities of power in any decision‐making process (Stacey et al, 2016).…”

Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making

“…PE focuses on improving insight and giving practical support on managing the condition. SDM promotes collaboration between patients and clinicians, where information is shared and patients are supported to express and achieve informed preferences about their treatment (6).…”