Shared treatment decision-making and empowerment related outcomes in psychosis: Systematic review and meta-analysis

Abstract

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.

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

“…Managers need to provide sustainable structures, with a clear vision of the new method as constituting a formal part of the ongoing activities. Although SDM is mentioned in key policy documents in Sweden and internationally, there are no incentives built into organisational structures and it is not promoted systematically at national, regional, or organisational levels (Stovell et al, 2016). A need to foster cultural change among managers, clinicians and users may be seen as well as a prerequisite for structural change, and this is described in the area of user involvement as a considerable challenge (Slade, 2017).…”

“…This finding mirrors international implementation studies on SDM which illustrate that the desire for participation is still greater than the degree of actual participation in practice. In existing research, a number of barriers are outlined related to a successful implementation of SDM, including time constraints, excessive workload of staff, lack of training to staff and users, and lack of access to medical information and decision support to users (Duncan et al, 2010; Morant et al, 2015; Stovell et al, 2016). In the actual implementation, the first training day was initially conceived of as an attempt to lift theories and principles related to participation, to a level that could be discussed and that would lay the groundwork for a shared approach in relation to values, knowledge and required structural changes.…”

“…Shared decision making, SDM, in psychiatric care, supports users to experience greater empowerment, including a subjective sense of involvement in treatment, self-efficacy, autonomy and reduced coercion (Stovell, Morrison, Panayiotou, & Hutton, 2016). SDM diverges radically from compliance, which is often a primary focus in treatment planning, since it assumes that two experts—the user and the practitioner—must share their respective knowledge, experience and viewpoints and collaboratively agree upon the choice of treatment.…”

“…SDM diverges radically from compliance, which is often a primary focus in treatment planning, since it assumes that two experts—the user and the practitioner—must share their respective knowledge, experience and viewpoints and collaboratively agree upon the choice of treatment. Despite these potential benefits, research on SDM and its implementation in practice in psychiatric care is still at a formative stage (Morant, Kaminskiy, & Ramon, 2015; Stovell et al, 2016). Attempts to describe and measure the benefits of SDM in psychiatric care have often been compromised by poor implementation (Morant et al, 2015; Ramon et al, 2017; Slade, 2017; Stovell et al, 2016).…”

“…Despite these potential benefits, research on SDM and its implementation in practice in psychiatric care is still at a formative stage (Morant, Kaminskiy, & Ramon, 2015; Stovell et al, 2016). Attempts to describe and measure the benefits of SDM in psychiatric care have often been compromised by poor implementation (Morant et al, 2015; Ramon et al, 2017; Slade, 2017; Stovell et al, 2016). In the field of somatic care, SDM has been described as a process of supportive collaboration between users and staff, drawing on user’s preferences and values, and the best available evidence to discuss multiple options and reach a consensus in care (Duncan, Best, & Hagen, 2010; O’Connor et al, 2007).…”