Training patients with schizophrenia to share decisions with their psychiatrists: a randomized-controlled trial
Abstract
Purpose Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients' communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence.Methods Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient-doctor interaction such as question asking or giving feedback.Results N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients' participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists' estimate) their behavior in psychiatric consultations.Conclusions While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients' active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.
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No differences regarding treatment adherence were found at 6 and 12 months after discharge between SDM and control groups.
“No differences regarding the treatment adherence were found at 6 and 12 months after discharge”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [43]
Patients in the SDM group reported an increase in participation preferences and wish to take over more responsibility for medical decision.
“Patients in the SDM group reported an increase in their levels of participation preferences and their wish to take over more responsibility for medical decision.”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [43]
Cites
Decision aids for people facing health treatment or screening decisions
Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001431.pub5 · Cited by 6,685 · see citing works
Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence
Morisky, D. E., Green, L. W., & Levine, D. M. (1986) · Medical Care · doi:10.1097/00005650-198601000-00007 · Cited by 5,304 · see citing works
Horne, R., & Weinman, J. (1999) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00057-4 · Cited by 2,201 · see citing works
Patients’ participation in medical care
Greenfield, S., Kaplan, S. H., Ware, J. E., Yano, E. M., & Frank, H. J. L. (1988) · Journal of General Internal Medicine · doi:10.1007/bf02595921 · Cited by 1,117 · see citing works
Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses
Thompson, K. N., Kulkarni, J., & Sergejew, A. A. (2000) · Schizophrenia Research · doi:10.1016/s0920-9964(99)00130-9 · Cited by 997 · see citing works
Measuring patients’ desire for autonomy
Ende, J., Kazis, L. E., Ash, A. S., & Moskowitz, M. A. (1989) · Journal of General Internal Medicine · doi:10.1007/bf02596485 · Cited by 938 · see citing works
Decision aids for people facing health treatment or screening decisions
O'Connor, A. M. C., Bennett, C. L., Stacey, D., Barry, M. J., Col, N. F., Eden, K., Entwistle, V. A., Fiset, V., Holmes-Rovner, M. M., Khangura, S. D., et al. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001431.pub2 · Cited by 693 · see citing works
A self‐report Insight Scale for psychosis: reliability, validity and sensitivity to change
Birchwood, M. J., Smith, J., Drury, V., Healy, J., Macmillan, F., & Slade, M. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb01487.x · Cited by 676 · see citing works
Haro, J. M., Kamath, S., Ochoa, S., Novick, D., Rele, K., Fargas, A., Rodríguez, M. J., Rele, R., Orta, J., Kharbeng, A., et al. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.107.s416.5.x · Cited by 659 · see citing works
The difficult doctor-patient relationship: somatization, personality and psychopathology.
Hahn, S., Thompson, K., Wills, T., Stern, V., & Budner, N. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90212-7 · Cited by 276 · see citing works
Shared decision making interventions for people with mental health conditions
Duncan, E., Best, C., & Hagen, S. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007297.pub2 · Cited by 256 · see citing works
The Effects of Patient Communication Skills Training on Compliance
Cegala, D. J. (2000) · Archives of Family Medicine · doi:10.1001/archfami.9.1.57 · Cited by 198 · see citing works
Shared Decision Making and Long-Term Outcome in Schizophrenia Treatment
Hamann, J., Cohen, R., Leucht, S., Busch, R. M., & Kissling, W. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0703 · Cited by 184 · see citing works
Self-citationDeegan, P. E., Rapp, C. A., Holter, M. C., & Riefer, M. (2008) · Psychiatric Services · doi:10.1176/appi.ps.59.6.603 · Cited by 173 · see citing works
Deegan, P. E., Rapp, C., Holter, M., & Riefer, M. (2008) · Psychiatric Services · doi:10.1176/ps.2008.59.6.603 · Cited by 173 · see citing works
Hamann, J., Mendel, R., Cohen, R., Heres, S., Ziegler, M. D., Bühner, M., & Kissling, W. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.8.1107 · Cited by 155 · see citing works
Self-citationParticipation preferences of patients with acute and chronic conditions
Hamann, J., Neuner, B., Kasper, J., Vodermaier, A., Loh, A., Deinzer, A., Heesen, C., Kissling, W., Busch, R. M., Schmieder, R. E., et al. (2007) · Health Expectations · doi:10.1111/j.1369-7625.2007.00458.x · Cited by 149 · see citing works
Self-citationSeale, C. F., Chaplin, R., Lelliott, P. T., & Quirk, A. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.11.002 · Cited by 148 · see citing works
Priebe, S., Kelley, L., Omer, S., Golden, E., Walsh, S., Khanom, H., Kingdon, D., Rutterford, C., McCrone, P., & McCabe, R. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000430991 · Cited by 140 · see citing works
Recent advances in shared decision making for mental health
Patel, S. R., Henry, S. B., & Ruland, C. M. (2008) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32830eb6b4 · Cited by 126 · see citing works
Involving patients in decisions during psychiatric consultations
Goss, C., Moretti, F., Mazzi, M. A., Piccolo, L. D., Rimondini, M., & Zimmermann, C. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.048728 · Cited by 121 · see citing works
Trends and perspectives of shared decision-making in schizophrenia and related disorders
Beitinger, R., Kissling, W., & Hamann, J. (2014) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000057 · Cited by 108 · see citing works
Self-citationAdapting Shared Decision Making for Individuals With Severe Mental Illness
Hamann, J., & Heres, S. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201400307 · Cited by 95 · see citing works
Self-citationActivation, Self-management, Engagement, and Retention in Behavioral Health Care
Alegria, M. M., Carson, N. J., Flores, M. W., Li, X., Shi, P., Lessios, A. S., Polo, A. J., Allen, M., Fierro, M., Interian, A., et al. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.4519 · Cited by 83 · see citing works
Hamann, J., Mendel, R., Meier, A., Asani, F., Pausch, E., Leucht, S., & Kissling, W. (2011) · Psychiatric Services · doi:10.1176/ps.62.10.pss6210_1218 · Cited by 76 · see citing works
Self-citationShared decision-making in ongoing outpatient psychiatric treatment
McCabe, R., Khanom, H., Bailey, P., & Priebe, S. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2012.12.020 · Cited by 60 · see citing works
Stein, B. D., Kogan, J. N., Mihalyo, M. J., Schuster, J., Deegan, P. E., Sorbero, M., & Drake, R. E. (2012) · Community Mental Health Journal · doi:10.1007/s10597-012-9528-8 · Cited by 57 · see citing works
Concurrent Validity of the Global Assessment of Functioning Scale for Clients with Schizophrenia
Schwartz, R. C. (2007) · Psychological Reports · doi:10.2466/pr0.100.2.571-574 · Cited by 53 · see citing works
Emerging Trends and Future Directions in Patient Communication Skills Training
Cegala, D. J. (2006) · Health Communication · doi:10.1207/s15327027hc2002_3 · Cited by 50 · see citing works
Hamann, J., Maris, N., Iosifidou, P., Mendel, R., Cohen, R., Wolf, P., & Kissling, W. (2013) · International Journal of Social Psychiatry · doi:10.1177/0020764013482311 · Cited by 37 · see citing works
Self-citationLangewitz, W. A., Keller, A., Denz, M., Wössmer, B., & Kiss, A. (1995) · PubMed · Cited by 36 · see citing works
Farin‐Glattacker, E., Schmidt, E., & Gramm, L. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.11.005 · Cited by 29 · see citing works
Glattacker, M., Gulich, M., Farin, E., & Jäckel, W. H. (2007) · Physikalische Medizin Rehabilitationsmedizin Kurortmedizin · doi:10.1055/s-2007-940008 · Cited by 15 · see citing works
[The therapeutic concept of euthymic treatment. The little school of pleasure].
Lutz, R. (2005) · PubMed · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Interventions for increasing the use of shared decision making by healthcare professionals
Légaré, F., Adekpedjou, R., Stacey, D., Turcotte, S., Kryworuchko, J., Graham, I. D., Lyddiatt, A., Politi, M. C., Thomson, R., Elwyn, G., et al. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006732.pub4 · Cited by 698 · see citing works
Fiorillo, A., Barlati, S., Bellomo, A., Corrivetti, G., Nicolò, G., Sampogna, G., Stanga, V., Veltro, F., Maina, G., & Vita, A. (2020) · Annals of General Psychiatry · doi:10.1186/s12991-020-00293-4 · Cited by 110 · see citing works
Shared decision-making interventions for people with mental health conditions
Aoki, Y., Yaju, Y., Utsumi, T., Sanyaolu, L. N., Storm, M., Takaesu, Y., Watanabe, K., Watanabe, N., Duncan, E., & Edwards, A. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007297.pub3 · Cited by 106 · see citing works
Perceptions of shared decision‐making in severe mental illness: An integrative review
Huang, C., Plummer, V., Lam, L., & Cross, W. M. (2019) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12558 · Cited by 76 · see citing works
Hamann, J., Holzhüter, F., Blakaj, S., Becher, S., Haller, B., Landgrebe, M., Schmauß, M., & Heres, S. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796020000505 · Cited by 56 · see citing works
Self-citationShared decision making for adults with severe mental illness: A concept analysis
Aoki, Y. (2020) · Japan Journal of Nursing Science · doi:10.1111/jjns.12365 · Cited by 51 · see citing works
Thomas, E. C., Ben‐David, S., Treichler, E. B. H., Roth, S. C., Dixon, L. B., Salzer, M. S., & Zisman‐Ilani, Y. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202000429 · Cited by 48 · see citing works
Chmielowska, M., Zisman‐Ilani, Y., Saunders, R., & Pilling, S. (2023) · International Journal of Social Psychiatry · doi:10.1177/00207640221140291 · Cited by 45 · see citing works
Davies, C., Fattori, F., O’Donnell, D., Donnelly, S., Shé, É. N., Shea, M. O., Prihodová, L., Gleeson, C., Flynn, Á., Rock, B., et al. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4802-x · Cited by 40 · see citing works
Adisso, É. L., Zomahoun, H. T. V., Gogovor, A., & Légaré, F. (2020) · PLoS ONE · doi:10.1371/journal.pone.0240371 · Cited by 33 · see citing works
Lin, Y.-Y., Yen, W.-J., Hou, W.-L., Liao, W.-C., & Lin, M.-L. (2022) · Healthcare · doi:10.3390/healthcare10030492 · Cited by 32 · see citing works
“Healthcare professionals encourage patient involvement in shared decision making with their physician to express their preference and opinion in treatment selection to increase their adherence to medication [22].”
BackgroundWehking, F., Debrouwere, M., Danner, M., Geiger, F., Bünzen, C., Lewejohann, J.-C., & Scheibler, F. (2023) · Journal of Public Health · doi:10.1007/s10389-023-01962-w · Cited by 27 · see citing works
Need for information in a representative sample of outpatients with schizophrenia disorders
Andrade, M. C. R., Slade, M., Bandeira, M. D. B., Evans-Lacko, S. E., Martin, D., & Andreoli, S. B. (2018) · International Journal of Social Psychiatry · doi:10.1177/0020764018776350 · Cited by 25 · see citing works
Morán‐Sánchez, I., Gómez‐Vallés, P., Bernal‐López, M. Á., & Pérez-Cárceles, M. D. (2019) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13246 · Cited by 24 · see citing works
Becher, S., Holzhüter, F., Heres, S., & Hamann, J. (2021) · Health Expectations · doi:10.1111/hex.13313 · Cited by 22 · see citing works
Self-citationMetz, M. J., Elfeddali, I., Veerbeek, M., de Beurs, E., Beekman, A. T. F., & Feltz-Cornelis, C. M. V. D. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199795 · Cited by 22 · see citing works
Jin, H., He, M., Xie, W., Xiong, Z., Deng, Z., & Li, Y. (2023) · Medicina · doi:10.3390/medicina59091664 · Cited by 20 · see citing works
Pérez‐Revuelta, J. I., González‐Sáiz, F., Paño, J. M. P., Mongil-Sanjuan, J. M., Rodríguez‐Gómez, C., Muñoz-Manchado, L. I., Mestre-Morales, J., Berrocoso, E., & Moreno, J. M. V. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.107656 · Cited by 20 · see citing works
Peterson, K., Anderson, J., & Bourne, D. S. (2018) · Europe PMC (PubMed Central) · Cited by 20 · see citing works
Vitger, T., Austin, S. F., Petersen, L., Tønder, E. S., Nordentoft, M., & Korsbek, L. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2143-2 · Cited by 18 · see citing works
Treichler, E. B. H., Avila, A., Evans, E. A., & Spaulding, W. D. (2018) · Psychological Services · doi:10.1037/ser0000275 · Cited by 16 · see citing works
Wesseldijk-Elferink, I. J. M., Hendriks, A. W., & van den Heuvel, S. C. G. H. (2021) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2021.07.007 · Cited by 13 · see citing works
Siafis, S., Bursch, N., Müller, K., Schmid, L., Schuster, F., Waibel, J., Huynh, T., Matthes, F., Rodolico, A., Brieger, P., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04036-5 · Cited by 13 · see citing works
Self-citationBrooks, H. L., Harris, K., Bee, P., Lovell, K., Rogers, A. E., & Drake, R. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-017-0149-z · Cited by 13 · see citing works
Ismail, M. A., & Midin, M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.680800 · Cited by 12 · see citing works
Francis, C. J., Hazelton, M., & Wilson, R. (2024) · Health Expectations · doi:10.1111/hex.70134 · Cited by 8 · see citing works
Pillen, H., Attrill, S., Fisher, A. C., Forte, S., Brebner, C., & Robinson, S. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2337099 · Cited by 10 · see citing works
Fitzgerald, I., Howe, J., Maidment, I. D., Wallace, E., Zisman‐Ilani, Y., Højlund, M., O’Dwyer, S., Dhubhlaing, C. N., Crowley, E. K., & Sahm, L. J. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf059 · Cited by 8 · see citing works
Yu, H. H., Sun, Y., Qin, M., Ren, J., Yu, K., Jin, S., Zhou, Y.-Q., & Liu, L. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05023-0 · Cited by 7 · see citing works
Agbadjé, T. T., Riganti, P., Adisso, É. L., Adekpedjou, R., Boucher, A., Nunciaroni, A. T., Franco, J. V. A., Yanzi, M. V. R., & Légaré, F. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265401 · Cited by 7 · see citing works
„Shared decision-making“ in der Akutpsychiatrie
Heres, S., & Hamann, J. (2017) · Der Nervenarzt · doi:10.1007/s00115-017-0359-2 · Cited by 6 · see citing works
Self-citationShared Decision-Making in the Management of Schizophrenia: A Systematic Review
Jackson, K. N., Lee, A. G., Ali, J. M., Vargas, S., Ulloa-Franco, P., Manning, T., Jimoh, Z. G., & Hossain, M. M. (2025) · Cureus · doi:10.7759/cureus.87069 · Cited by 2 · see citing works
Niv, N., Issa, F., Goldberg, R., Khandekar, P., McGraw, K., Reston, J. T., Ford, S. C., Katz, I. R., & Resnick, S. G. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf035 · Cited by 2 · see citing works
Shared Decision Making in Mental Health: International Perspectives on Implementation
Ramon, S., Zisman‐Ilani, Y., Quirk, A., & Zisman-Ilani (2022) · Frontiers research topics · doi:10.3389/978-2-88974-217-2 · Cited by 2 · see citing works
Salakay, E. N. H., Mahu, G. F. P. H., & Rahayu, A. S. (2024) · Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) · doi:10.22146/rpcpe.87798 · Cited by 1 · see citing works
Montaigne, E., Côté, I. M., Dallaire, C., Durand, P. J., Gagnon, M., Giroux, D., Hudon, C., Kröger, E., Légaré, F., Singamalum, S., et al. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.109409 · Cited by 1 · see citing works
Shared Decision Making im allgemeinpsychiatrischen Akutsetting
Heres, S., Holzhüter, F., & Hamann, J. (2021) · Nervenheilkunde · doi:10.1055/a-1401-3586 · Cited by 1 · see citing works
Self-citationde la Espriella, R., Cepeda, M., & Gómez–Restrepo, C. (2024) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2024.07.002
Kronkvist, M. B., Jönsson, P. D., & Sandlund, M. (2025) · Journal of Psychosocial Rehabilitation and Mental Health · doi:10.1007/s40737-024-00446-8
Visser, R., Veehof, M. M., & van Hogen-Koster, S. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1530427
Siafis, S., Bursch, N., Müller, K., Schmid, L., Schuster, F., Waibel, J., Huynh, T., Matthes, F., Rodolico, A., Brieger, P., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20098391
Self-citationDong, J., Lü, M. K., Chen, Y., Zisman‐Ilani, Y., Feng, Y., Zhang, S., Huang, H., & Zhou, Y. (2026) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s610845
- Authors
- Hamann, J., Parchmann, A., Sassenberg, N., Bronner, K., Albus, M., Richter, A., Hoppstock, S., & Kissling, W.
- Affiliations
- Technical University of Munich (DE)
- Isar-Amper-Klinikum München-Ost (DE)
- Corresponding author
- Hamann, Johannes
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2016-12-31
- Volume
- 52
- Issue
- 2
- Pages
- 175-182
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2562265673
- Cited by
- 42
- References
- 34
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 2
- FWCI
- 6.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Funders
- Bundesministerium für Bildung und Forschung (01GX1032)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- schizophrenia, shared decision-making, patient training, patient participation, medication adherence, patient-doctor communication, psychiatric consultation, inpatient care, role play
- MeSH terms
- Adolescent, Adult, Aged, Decision Making, Female, Germany, Hospitals, Psychiatric, Humans, Inpatients, Male, Middle Aged, Patient Compliance, Patient Participation, Physician-Patient Relations, Schizophrenia, Outcome Assessment, Health Care, Young Adult
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