Efficacy of shared decision making on treatment satisfaction for patients with first-admission schizophrenia: study protocol for a randomised controlled trial

Abstract

BackgroundShared decision making is a promising model for patient-centred medicine, resulting in better clinical outcomes overall. In the mental health field, interventions that consider the patient-centred perspective—such as patient quality of life, involvement in the treatment, treatment satisfaction, and working alliance—have increased and better clinical outcomes discovered for patients with schizophrenia. However, few studies have examined the efficacy of shared decision making for schizophrenia treatment. The objective of this study is to evaluate the effect of a shared decision making intervention compared to treatment as usual on patient satisfaction at discharge for first-admission patients with schizophrenia.Methods/DesignThis is a randomised, parallel-group, two-arm, open-label, single-centre study currently being conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. We are recruiting patients between 16 and 65 years old who are admitted to the ward with a diagnosis of schizophrenia without prior experience of psychiatric admission. Fifty-eight participants are being randomised into a shared decision making intervention group or a treatment as usual control group in a 1:1 ratio. The intervention program was developed based on a shared decision making model and is presented as a weekly course lasting the duration of the patients’ acute psychiatric ward stay. The primary outcome measure is patient satisfaction at discharge as assessed by the Client Satisfaction Questionnaire. Due to the study’s nature, neither the patient nor staff can be blinded.DiscussionThis is the first randomised controlled trial to evaluate the efficacy of shared decision making for patients with early-treatment-stage schizophrenia. The intervention program in this study is innovative in that it includes both of the patient and staff who are involved in the treatment.Trial registrationThe study has been registered with ClinicalTrials.gov as NCT01869660.

Involved, inputting or informing: “Shared” decision making in adult mental health care

“…Good relationships between family members and other health‐care team members were important facilitators to family input—as with SDM more broadly—respectful, working alliances facilitated family involvement. Team communication is important, to encourage staff to fully evaluate instances where service user permission is not granted, or to discourage staff from discounting family input due to caution about a possible carer “agenda.” Staff have a responsibility to prevent family members being subject to “courtesy stigma” or direct stigma from those who may hold the view that pathology is solely rooted in family relationships and dynamics .…”

“…Interventions which adopt person‐centred perspectives result in better clinical outcomes for people diagnosed with schizophrenia . Shared decision making (SDM) describes a model for health communication which encourages an egalitarian approach to decision making, recognizing the skills and experience offered by all participants involved in treatment decisions.…”

Relationship of treatment satisfaction to health‐related quality of life: findings from a cross‐sectional survey among hypertensive patients in Palestine

“…It is proposed that patients' decisions to continue, discontinue, or alter medical treatments are influenced by several factors including health status of the patient, prior experiences with particular treatment choices, desire to participate in treatment‐related decision making and real or anticipated beliefs regarding the effectiveness or harms of treatment . Patients' satisfaction with their medication or the services they receive has been shown to predict treatment success, continuation of pharmaceutical treatment, appropriate use of services, medical compliance and follow‐up with treatment plans . Treatment satisfaction may be a very useful outcome in clinical studies to provide insight into a patient's attitude towards hypertension treatment.…”

Feasibility and efficacy of shared decision making for first-admission schizophrenia: a randomized clinical trial

“…Details of the study protocol have been reported elsewhere [16]. The objective of this study was to evaluate the feasibility and efficacy of an SDM intervention compared to usual treatment on patient satisfaction at discharge and treatment continuation 6 months post-discharge for firstadmission patients with schizophrenia.…”