Abstract
BackgroundThe feasibility of shared decision making (SDM) for patients with schizophrenia remains controversial due to the assumed inability of patients to cooperate in treatment decision making. This study evaluated the feasibility and efficacy of SDM in patients upon first admission for schizophrenia.MethodsThis was a randomized, parallel-group, two-arm, open-label, single-center study conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. Patients with the diagnosis of schizophrenia upon their first admission were randomized into a SDM intervention group or a usual treatment group in a 1:1 ratio. The primary outcome was patient satisfaction at discharge. The secondary outcomes were attitudes toward medication at discharge and treatment continuation at 6 months after discharge.ResultsTwenty-four patients were randomly assigned. The trial was prematurely terminated due to slow enrollment. At discharge, the mean score on satisfaction was 23.7 in the SDM group and 22.1 in the usual care group (unadjusted mean difference: 1.6; 95% CI: −5.2 to 2.0). Group differences were not observed in attitude toward medication and treatment continuation. There was no statistically significant difference between the groups for the mean Global Assessment of Functioning score at discharge or length of stay as safety endpoint.ConclusionsNo statistical differences were found between the SDM group and usual care group in the efficacy outcomes and safety endpoints. Large trials are needed to confirm the efficacy of the SDM program upon first admission for schizophrenia.Trial registrationThe study has been registered with ClinicalTrials.gov as NCT01869660 (registered 27 May, 2013).
Highlights
The feasibility of shared decision making (SDM) for patients with schizophrenia remains controversial due to the assumed inability of patients to cooperate in treatment decision making
There has been some controversy among psychiatrists regarding the feasibility of SDM in regards to psychiatric treatment, when it involves the treatment of severe mental illnesses such as schizophrenia, with respect to patient vulnerability to paternalism and coercive treatment due to patient symptoms such as disorganized thinking and excessive suspicion [5, 6]
We examined whether our SDM intervention—a complex intervention including assessment of patient’s perception, regular meetings, and shared care planning—improved clinical outcomes for patients with schizophrenia in the early treatment stage
Summary
The feasibility of shared decision making (SDM) for patients with schizophrenia remains controversial due to the assumed inability of patients to cooperate in treatment decision making. SDM is expected to embody the idea of patient-centered care in clinical medicine. A meta-analysis found that, compared with usual care, SDM improves a patients’ knowledge acquisition, confidence, and active participation in treatment [4]. There has been some controversy among psychiatrists regarding the feasibility of SDM in regards to psychiatric treatment, when it involves the treatment of severe mental illnesses such as schizophrenia, with respect to patient vulnerability to paternalism and coercive treatment due to patient symptoms such as disorganized thinking and excessive suspicion [5, 6]. SDM had not targeted patients with severe mental illness such as schizophrenia because
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
