Lovell, Karina, Bee, Penny, Brooks, Helen, Cahoon, Patrick, Callaghan, Patrick, Carter, Lesley-Anne, Cree, Lindsey, Davies, Linda, Drake, Richard, Fraser, Claire, Gibbons, Chris, Grundy, Andrew, Hinsliff-Smith, Kathryn, Meade, Oonagh, Roberts, Chris, Rogers, Anne, Rushton, Kelly, Sanders, Caroline, Shields, Gemma, Walker, Lauren and Bower, Peter (2018) Embedding shared decision-making in the care of patients with severe and enduring mental health problems: the EQUIP pragmatic cluster randomised trial. PLoS ONE, 13 (8), 1-17, [e0201533]. (doi:10.1371/journal.pone.0201533).
Abstract
Background: severe mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning.
Methods: we cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of ‘autonomy support’. Primary and secondary outcomes were collected by self-report, six months after allocation.
Findings: in total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome.
Conclusions: an intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term.
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