Unwell in hospital but not incapable: cross-sectional study on the dissociation of decision-making capacity for treatment and research in in-patients with schizophrenia and related psychoses

Spencer, Benjamin T.; Gergel, Tania; Hotopf, Matthew; Owen, Gareth

doi:10.1192/bjp.2018.85

Cited by 23 publications

(17 citation statements)

References 28 publications

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“…The participants of this study were from clinically stable inpatients, which required careful interpretation of current findings. As Spencer et al [55] had mentioned, the hospitalized patients such as schizophrenia and related psychoses should not be regarded as exclusive areas for research, which was particularly applicable in China. The clinically stable inpatients, who occupied a large proportion of the schizophrenia group in China, was very representative and had not received enough attention.…”

Section: Discussionmentioning

confidence: 99%

Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia

et al. 2020

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Background: The underlying mechanism between hope and quality of life is as yet unknown. We aim to examine the potential mediating effect of depression and resilience and the moderated effect of sex in this well-established association. Methods: Two hundred seven patients diagnosed with schizophrenia were administered a questionnaire battery that measured hope, depression, resilience and QOL. A multiple mediation model was used to examine the mediating effect of resilience and depression on the association between hope and QOL. A subgroup analysis was performed and a moderated mediation model was examined to find and test the moderated effect of sex on the mediation model. We used Mplus to perform moderation and mediation analyses so that the mediators and moderator could function together in the same model. Result: Sex was the moderator on the direct path between hope and QOL. The relationship between hope and QOL was mediated by resilience and depression in both sexes. When compared with female patients, the effect of hope on QOL was completely mediated by resilience and depression in males. In female patients, the model was partially mediated, and the direct effect of hope on QOL was significantly negatively correlated with the level of hope. Conclusion: We present a conceptual model containing the mediated effects of resilience and depression and the moderated effect of sex between hope and QOL, which we believe facilitates the understanding of these associations. This model should be useful in the formulation of strategies to improve QOL.

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Section: Discussionmentioning

confidence: 99%

Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia

et al. 2020

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“…Although different mental disorders may compromise an individual's decision-making ability, it should not be assumed that a mentally ill individual lacks the capacity to appreciate the information and implications of participation in research or the capacity to consent to research. Indeed, there is evidence that people with schizophrenia and related psychoses commonly retain decision making capacity for research, despite lacking decision making capacity for treatment [34]. Evidence also suggests that other severely mentally ill patients can maintain substantial decisional capacity and be able to make choices that appear objectively reasonable [35].…”

Section: Implications and The Results Of The Policy Of Exclusion Frommentioning

confidence: 99%

No research for the decisionally-impaired mentally ill: a view from Montenegro

Dakić

2020

BMC Med Ethics

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Background: Many of the important elements of a valid informed consentcomprehension, voluntariness, and capacitycan be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent. Main body: Mental health research is often neglected and very low on the list of health research priorities, especially in low-and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet. To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed. Conclusions: Scientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patientsubjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research.

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“…However, in this earlier study, the negative correlation between insight and role preference was not significant, with a p = 0.09. Other previous studies seem to prove the contrary and show that a lack of insight had the strongest link to a lack of decision-making capacity relating to treatment (29). Poor insight is seen as the most common and absolute barrier to SDM among patients with schizophrenia (32, 47) and has been linked to a poorer perceived therapeutic alliance (73).…”

Section: Associated Factors Of Autonomous Role Preference Association Between Lower Levels Of Insight and Autonomous Role Preferencementioning

confidence: 91%

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

Ismail

Midin

2021

Front. Psychiatry

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Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia.Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses.Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = −0.33, 95% CI = −0.67 to −0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39–30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72–0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10–7.82).Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.

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Unwell in hospital but not incapable: cross-sectional study on the dissociation of decision-making capacity for treatment and research in in-patients with schizophrenia and related psychoses

Cited by 23 publications

References 28 publications

Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia

Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia

No research for the decisionally-impaired mentally ill: a view from Montenegro

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study

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