SYSTEMATIC REVIEW OF SHARED DECISION MAKING INTERVENTIONS FOR INDIVIDUALS WITH MENTAL HEALTH CONCERNS

Purpose:

This systematic review of shared decision making interventions sought to 1) determine the level of evidence for the effectiveness of shared decision making interventions for individuals who experience mental health concerns and 2) identify directions for future research and intervention development for shared decision making in mental health treatment.

Method:

A systematic search of Psychinfo, Pubmed and CINAHL-Plus (2008-2014) yielded 502 abstracts. Included in this review were studies that a) reported results of a shared decision making intervention (defined as one that aimed to facilitate communication and patient engagement), b) used at least a pre/post test study design, and c) targeted a consumer group with mental health issues. Design, participant, and methodological characteristics of each study were analyzed. Quality ratings were assigned by 2 reviewers using the Quality Assessment Tool for Quantitative Studies (Thomas et al, 2004). 

Result:

20 studies met criteria for this review, 14 of which were randomized controlled trials. Most interventions were delivered in outpatient settings. Intervention types included those targeted at increasing provider competencies (n=3), consumer competencies (n=3) or both (n=14). All but 3 of the studies included a written component in the intervention; 4 included video; 8 included web-based; and 19 were interactive.

Studies that measured patient attitudes/activation (n=9) generally found positive effects (n=7 with significant findings). Provider/consumer interactions were also effective in 5 of 6 studies. Functional outcomes including symptoms, hospital readmissions or follow up with treatment were measured in 11 studies and 6 found significant effects. Length of interventions ranged from 20 minutes to 12 months but there was no evidence that longer interventions were more effective. Interventions that focused solely on providers or solely on patients tended to narrowly define success in terms of patient activation or increased patient centeredness in the interactions compared to broader interventions that more often measured functional outcomes.

Conclusion:

Rigorous research on Shared Decision Making interventions has proliferated over the last four years; the majority of which employed rigorous study designs. Interventions that measured patient activation or patient centeredness have generally reported success in these outcomes. 

But, it is less clear whether this translates into improved functioning or treatment engagement. Just over half of studies in this review that measured functional outcomes found significant results, indicating promising directions for future research.