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044 Trends, challenges, and priorities for shared decision making in mental health: the first umbrella review
  1. Marta Chmielowska1,2,3,
  2. Yaara Zisman-Ilani3,4,
  3. Rob Saunders1,3,
  4. Stephen Pilling1,3
  1. 1Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
  2. 2The North East London NHS Foundation Trust Research and Development Department, London, UK
  3. 3Department of Clinical, Educational and Health Psychology, University College London, London UK
  4. 4Social and Behavioural Sciences, Temple University College of Public Health, Philadelphia, PA, USA

Abstract

Introduction Shared Decision Making (SDM) is a health communication model promoting patient- centred care that is not routinely utilised in mental health. Inconsistent definitions, models, measures, and the lack of sufficient evidence for the effectiveness of SDM interventions could explain the limited use of SDM in mental health. This umbrella review provides the first systematic analysis of global development trends and challenges of SDM research in mental health.

Methods A comprehensive search strategy was conducted in nine databases. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measures, comparisons, and outcomes.

Results 10 systematic reviews of SDM in mental health were included, with 100 nested studies from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions included treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported.

Discussion The current landscape of SDM in mental health is disconnected from the needs and experiences of potential end users; clinicians, patients, and family members. Most SDM interventions and tools were adapted from physical health and geared to psychopharmacological decision-making. The SDM in Mental Health Framework expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes to reduce heterogeneity across studies.

Conclusion This umbrella review clearly demonstrates the need for a redefined and more integrated SDM approach in mental health tailored to the diverse needs and preferences of people with mental illness and their unique care contexts.

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