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

Abstract

Background: The 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. Methods: This 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. Results: Twenty-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. Conclusions: No 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 registration: The study has been registered with ClinicalTrials.gov as NCT01869660 (registered 27 May, 2013).

Conceptual understanding and applicability of shared decision‐making in psychiatric care: An integrative review

“…(2016), who highlighted issues of power within the decision‐making process in inpatient psychiatric care. Furthermore, three intervention studies with a quantitative design performed (Hamann et al., 2006 and Ishii et al., 2017) or planned to perform (Hamann et al., 2017) interventions to improve shared decision‐making practices and patient involvement in acute psychiatric care. Moreover, a European study by Puschner et al.…”

“…Regarding psychiatric care, several authors underline the need for SMD practices to be based on a trustful and ongoing relationship between the patient and health professionals (Barnicot et al., 2017; Heres & Hamann, 2017; Ishii et al., 2017; Légaré & Witteman, 2013; Ramon et al., 2017). Other authors argue that SDM practices could empower patients and promote the patient's autonomy (Elwyn et al., 2012; Ramon et al., 2017; Simmons & Gooding, 2017).…”

“…Other authors argue that SDM practices could empower patients and promote the patient's autonomy (Elwyn et al., 2012; Ramon et al., 2017; Simmons & Gooding, 2017). Ideally, SDM should be carried out in a co‐productive manner in terms of recovery orientation and patient‐centredness (Heres & Hamann, 2017; Ishii et al., 2017; Ramon et al., 2017; Simmons & Gooding, 2017). Baker et al.…”

“…Among the selected articles, there were three intervention studies and one study protocol that specifically targeted SDM in psychiatry. The interventions aimed at assessing the feasibility and efficacy of SDM approaches in inpatient psychiatric care (Hamann et al., 2006; Ishii et al., 2017) or focused on the process of SDM within a training programme for patients and health professionals in community psychiatric services (Ramon et al., 2017). The outcome criteria regarding patients were as follows: satisfaction with treatment, perceived degree of involvement, frequency of decision‐making conflicts and assessment of SDM competencies of health professionals.…”

“…Further to the above, the patient–health professional relationship and the involvement of multiple health professionals during the SDM process have been claimed to positively influence the implementation of SDM in psychiatric practice (Barnicot et al., 2017; Heres & Hamann, 2017; Ishii et al., 2017; Légaré & Witteman, 2013; Loos et al., 2013; Ramon et al., 2017; Simmons & Gooding, 2017). Moreover, patient‐centred and recovery‐oriented approaches have been reported to be key in the SDM process (Heres & Hamann, 2017; Ishii et al., 2017; Ramon et al., 2017; Simmons & Gooding, 2017). Patient‐centred care in conjunction with SDM is fundamentally based on a trustful relationship between the patient and the healthcare provider, in which the preferences and needs of the patient should be considered in any clinical decision.…”