Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

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; Bower, Peter

doi:10.1371/journal.pone.0201533

Cited by 36 publications

(58 citation statements)

References 41 publications

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“…However, many mental health inpatients report not feeling sufficiently involved in decisions around their care (CQC, ) and how best to embed shared decision‐making in practice is unknown. A recent cluster randomized trial in community mental health teams in the UK ( n = 18 teams, 350 staff, 604 patients, 90 carers) (Lovell et al, ) tested the efficacy of a co‐delivered training intervention designed to improve patient and carer involvement in care planning. The trial was well conducted, and training was well attended and acceptable to staff; however, despite this, it had no significant effects on patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

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The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

Clark

Lekkai

Murphy

et al. 2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint. Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan. However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. What this paper adds to existing knowledge? This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended. Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients. Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. What are the implications for practice? To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients. Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. AbstractIntroductionAn international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited.AimsTo evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care.MethodsMixed methods—quality ratings and interviews with relatives and nurses.ResultsPositive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour.DiscussionThe potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed.Implications for practiceMental health professionals implementing PBSPs should engage with relatives and p...

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Section: Discussionmentioning

confidence: 99%

“…agency) staff, would be an improvement. However, the EQUIP trial (Lovell et al, ) demonstrates clearly that training alone is insufficient to effect change in care delivery.…”

Section: Discussionmentioning

confidence: 99%

The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

Clark

Lekkai

Murphy

et al. 2019

Psychiatric Ment Health Nurs

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“…This study was part of a larger programme of research to enhance service user and carer involvement in mental health services through the development and evaluation of a training programme for mental health professionals [36]. People were eligible to take part in the trial if they were aged over 18 and had a diagnosis of a severe and enduring mental health problem (including psychosis, bipolar disorder, schizophrenia and personality disorder).…”

Section: Methodsmentioning

confidence: 99%

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

et al. 2020

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Background: Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems. Methods: A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model. Results:The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks. Conclusions: Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.

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“…Such questions are pertinent to shared decision making and are likely to be of high interest to women and clinicians. This type of inquiry is becoming more common in other areas of health care, such as mental health care and chronic disease management, and will be important to guide the practical translation of the results to practice.…”

Section: Next Steps: Recommendations For Future Researchmentioning

confidence: 99%

The ARRIVE Trial: Interpretation from an Epidemiologic Perspective

Carmichael

Snowden

2019

J Midwife Womens Health

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The findings of the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) were recently published. This multisite randomized trial was designed to provide evidence regarding whether labor induction or expectant management is associated with increased adverse perinatal outcomes and risk of cesarean birth among healthy nulliparous women at term. The trial reported that the primary outcome, a composite of adverse neonatal outcomes, was not significantly different between the 2 groups; the principal secondary outcome, cesarean birth, was significantly more common among women whose pregnancy was expectantly managed than among women whose labor was induced at 39 weeks. These results have the potential to change existing practice. Several aspects of the study design may influence its potential internal and external validity and should be considered in order to make sound causal inferences from this trial, which will in turn affect how its findings are translated to practice. Although chance and confounding are of minimal concern, given the sample size and randomization used in the study, selection bias may be a concern. Studies are vulnerable to selection bias when the sample population differs from eligible nonparticipants, including in randomized controlled trials. External validity is defined as the extent to which the study population and setting are representative of the larger source population the study intends to represent. External validity may be limited given the characteristics of the women enrolled in the ARRIVE trial and the practice settings where the study was conducted. This brief report provides concrete suggestions for further analyses that could help solidify conclusions from the trial, and for further research questions that will continue advancement toward answering this complex question of how best to manage labor and birth decisions at full term among low-risk women.

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Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

Cited by 36 publications

References 41 publications

The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

The ARRIVE Trial: Interpretation from an Epidemiologic Perspective

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