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

Abstract

Background: Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental health. Aims: (1) Provide the first systematic analysis of global development trends and challenges of SDM research; (2) clarify the meaning, role, and measurement of SDM in mental health; (3) create a theoretical framework for key effective SDM components to guide future development and implementation of SDM interventions. Methods: A comprehensive search strategy was conducted in CINAHL, PubMed, Scopus, MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, and PsycInfo. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measurement tools, comparisons, and outcomes. Results: Ten10 systematic reviews of SDM in mental health were included with 100 nested studies spanning from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions include treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported. Conclusions: The current landscape of SDM in mental health is overwhelmingly disconnected from the needs and experiences of potential end-users; clients, clinicians, and family members. Most SDM interventions and tools were adapted from physical health and are mainly geared to psychopharmacological decision-making. The SDM in Mental Health Framework (SDM-MH), developed here, expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes of SDM in mental health to reduce heterogeneity across studies.

Awakening on antipsychotic medication: A call to action.

“…SDM is an evidence-based health communication approach to improve interpersonal interactions and communication between individuals and their providers (Zisman-Ilani et al, 2017; Zisman-Ilani, Roth, & Mistler, 2021). Sometimes, the SDM process includes family and/or other carers as well (Chmielowska et al, 2023). SDM often includes decision aids that help people learn more about treatment options as well as values clarification exercises that help people express their preferences to providers.…”

Shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): protocol for a realist review

“…[4] Interventions assessed typically include a combination of decision aids, [17,18] educational interventions for patients and/or clinicians, [14] and digital support tools. [19,20,21] To date, the effect size of studied interventions has proven variable and inconsistent [2,22] and positive results are generally smaller than in somatic medicine. [4,22,23] Reasons for varying results, including an understanding of which elements of efficacious interventions are hypothesized to be responsible for results and how they produced their effects, are largely missing from the literature.…”

“…[19,20,21] To date, the effect size of studied interventions has proven variable and inconsistent [2,22] and positive results are generally smaller than in somatic medicine. [4,22,23] Reasons for varying results, including an understanding of which elements of efficacious interventions are hypothesized to be responsible for results and how they produced their effects, are largely missing from the literature. An understanding of these mechanisms is important to support increased and standardised application of SDM in antipsychotic treatment decisions.…”

Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study

“…In SDM, these two types of expert work together, sharing information, discussing alternatives and comparing options, aiming to arrive at a preference-based decision that respects what matters most to the patient [ 4 ]. This process may also include other health and social care professionals and people from the social network of the patient such as family members or peer support workers [ 5 ].…”