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

Journal article


Lovell, K, Bee, P, Brooks, H, Cahoon, P, Callaghan, P, Carter, L-A, Cree, L, Davies, L, Drake, R, Fraser, C, Gibbons, C, Grundy, A, Hinsliff-Smith, K, Meade, O, Roberts, C, Rogers, A, Rushton, K, Sanders, C, Shields, G, Walker, L and Bower, P (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).
AuthorsLovell, K, Bee, P, Brooks, H, Cahoon, P, Callaghan, P, Carter, L-A, Cree, L, Davies, L, Drake, R, Fraser, C, Gibbons, C, Grundy, A, Hinsliff-Smith, K, Meade, O, Roberts, C, Rogers, A, Rushton, K, Sanders, C, Shields, G, Walker, L and Bower, P
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.

KeywordsMD Multidisciplinary; General Science & Technology
Year2018
JournalPLoS ONE
Journal citation13 (8)
ISSN1932-6203
Digital Object Identifier (DOI)doi:10.1371/journal.pone.0201533
Publication dates
Print22 Aug 2018
Publication process dates
Deposited04 Sep 2018
Accepted16 Jul 2018
Publisher's version
License
CC BY 4.0
File Access Level
Open
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