Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review

Abstract

Background Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies–personalized care planning and shared decision making–within collaborative care programs for depression and anxiety disorders in primary care. Methods We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. Results In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. Conclusion This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.

Military Environmental Exposures

“…Recent studies show that personalized care planning that includes multidisciplinary collaboration, role clarity, patient-centered interactions, and a holistic approach can benefit patients. 32,33 Multidisciplinary collaboration with role clarity. Collaboration that engages all stakeholders allows for the provision of personalized health care to veterans.…”

“…34,35 Personalized care planning and shared decision-making can help to encourage the integration of expertise from each profession, support the synchronization of services, and improve continuity of care. 33 Patient-centered interactions. According to the National Academies of Sciences, Engineering, and Medicine, patient-centered care refers to the provision of care that is respectful of and responsive to patient preferences, needs, and values and ensures the patient's values guide all clinical decisions.…”

“…Creating a care plan is necessary for optimal care, with the aim of improving the overall quality of life of the veteran. Recent studies show that personalized care planning that includes multidisciplinary collaboration, role clarity, patient-centered interactions, and a holistic approach can benefit patients 32, 33…”

“…However, multidisciplinary collaboration with role clarity can help determine priorities, save time, and foster an environment for transparent dialogue and decision-making 34, 35. Personalized care planning and shared decision-making can help to encourage the integration of expertise from each profession, support the synchronization of services, and improve continuity of care 33…”

A qualitative examination of the implementation of a perinatal collaborative care program

“…After referral, the CM and patient connect in-person or via telemedicine to complete formal screening for psychiatric comorbidities and a thorough risk-assessment for suicidality and infant harm. Informed by this assessment, as recommended in the literature (Menear et al, 2022), the CM engages in shared decision-making for an initial care plan with the patient and her obstetric clinician. The CM provides evidence-based psychotherapy for women with mild or moderate depression (Behavioral Activation (Martell et al, 2013), CBT (Beck et al, 1979)).…”