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Table 1 Main features of the included studies

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

Author (Country), Year Study design Sample size and setting Diagnosis Inclusion criteria Intervention Outcome
Hamann et al. (Germany), [38] Pilot study with random allocation N = 61 patients (shared decision making training, N = 32; control condition, N = 29); acute psychiatric ward Schizophrenia, schizoaffective disorder Patients’ age 18–60 years Shared decision-making training: five 1-h group sessions, including the importance of shared decision-making process, motivational aspects and the use of role-plays
Control condition: five-sessions of cognitive training group
Patients receiving the shared decision-making training reported higher participation preferences and increased patients’ desire to have more responsibility in treatment decisions, which continued at 6-month follow-up
An et al. (Korea), [39] Quasi-experimental, non-equivalent pre/post-test design N = 60 (Experimental group, N = 29; Control group, N = 31); acute psychiatric ward Schizophrenia or schizoaffective disorder based on DSM-IV-TR criteria Patients’ age 19 years old or older SMD training program: consists of 8-weekly group sessions based on the SDM guidelines. The topics include: general information on the program; education on the significance of SDM; communication; expression of patient’s needs and preferences for treatment; understanding the needs of others; coordinating opinions in decision-making situations; demonstrating the SDM in various scenarios; practicing the SDM in real situation
Control group: treatment as usual
Patients receiving the SDM training program report an improvement in the levels of self-esteem, problem-solving ability, and quality of life compared to patients allocated in the control group
McCabe et al. (UK), [40] Cluster randomised control trial N = 72 patients (Experimental group, N = 36; Control group, N = 36), N = 12 psychiatrists; psychiatric out-patient clinics or community mental health services Schizophrenia or schizoaffective disorder according to ICD-10 criteria Patients’ age: 18–65 years TEMPO training: focused to mental health professionals, including the following topics: understanding the patient with psychotic experiences: reflecting on the patient’s experience and the professional and emotional response to psychotic symptoms; communication techniques for working with positive and negative symptoms; empowerment of the patient; involvement in decision-making about medication
Control group: treatment as usual
Patients treated by psychiatrists receiving the TEMPO training reported a more positive therapeutic relationship as did psychiatrists
Ramon et al. (United Kingdom), [41] Naturalistic study, before and after, uncontrolled design N = 47 service users, N = 35 care-coordinators and N = 12 psychiatrists; community services
for adults with long-term mental health problems
Schizophrenia, bipolar disorder and depression Patients’ age: 18–65 years; in charge at rehabilitation and recovery services for at least 6 months; taking any psychiatric medication for at least 6 months Training was delivered to separate groups of service users, psychiatrists and care coordinators. The core content was the same for all groups and focused on the process of SDM. Training sessions were delivered at fortnightly or monthly intervals. 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 served by MyCHOIS–CommonGround clinics between 2011–2014 MyCHOIS–CommonGround: Web-based shared decision-making application on outpatient mental health treatment engagement and on antipsychotic medication adherence
Control group: simple random sample of adult Medicaid receiving a mental health clinic service
At one-year follow-up, patients in the MyCHOIS–CommonGround report higher level of engagement in outpatient mental health services and of adherence to antipsychotic medication compared to the control group
Kane et al. (USA), [35] Randomized controlled trial N = 255 patients; community “real world” mental health clinics Schizophrenia diagnosis confirmed by SCID-5 Patients’ age: 18-35 years; less than 5 years of antipsychotic lifetime use Experimental group: to provide LAI treatment with long-acting aripiprazole monohydrate (Aripiprazole Once Monthly). Clinicians received a training course on the role of non-adherence in relapse and hospitalization, effectiveness of LAI antipsychotic, shared decision-making principles, communication strategies
Treatment as usual group: defined as the Clinician’s Choice condition
91% of patients accepted at least one LAI antipsychotic during the first 3 months participation to the trial