Shared Decision Making and Behavioral Support Interventions for People With Severe Mental Illness and Tobacco Dependence

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Objective: People with severe mental illness (e.g., schizophrenia and severe mood disorders) are more likely to smoke tobacco and less likely to quit than the general population. Current recommendations for treatment combine evidence-based medications and behavioral interventions tailored to each individual's needs. One way to individualize treatment is through shared decision making, in which the patient and the provider negotiate a research-based plan that accommodates the patient's preferences and values. This paper examines the current literature and discusses what role shared decision making might have in the treatment of tobacco dependence for people with severe mental illness. Methods: We conducted a search of Ovid/Medline using search terms (decision aid OR shared decision-making OR decision support) AND (smoking cessation OR tobacco dependence OR nicotine dependence). Results: Of the 202 reports found, three met the review criteria of assessing the impact of a decision aid or behavioral support intervention on user initiation of smoking cessation treatments. Two of the studies assessed directive behavioral support interventions intended to increase motivation to quit (including among smokers with severe mental illnesses) and one study assessed a neutral decision support intervention. Users of the decision aid increased quit behaviors, and users of the behavioral support interventions were more likely to initiate cessation treatments. Conclusions: Emerging research suggests that decision aids may increase quit behavior and use of smoking cessation treatment, even among those with severe mental illnesses. Further research is needed to assess whether decision aids increase use of shared decision making in tobacco cessation treatment.