When does shared decision making is adopted in psychiatric clinical practice? Results from a European multicentric study
Open accessAbstract
To identify factors associated with the use of shared decision making in routine mental health care in a large multicenter European study. Data have been collected within the study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR), which is a naturalistic, longitudinal, observational study carried out in six European countries. Patients with a severe mental illness attending outpatient units and their treating clinicians have been recruited. Clinicians' Clinical Decision Making (CDM) styles have been explored through the Clinical Decision Making Style Scale. Patients' clinical and social outcomes have been assessed through validated assessment instruments. The sample consisted of 588 patients and 213 professionals. Professionals were mainly psychiatrists (35.7%), nurses (21.6%), support workers, social workers or occupational therapists (24.9%), psychologists (9.9%) or trainees in psychiatry (4.7%). In the majority of cases, clinicians adopted a shared CDM style. Shared CDM was more frequently adopted with patients with psychotic disorders, with a better quality of life and social functioning. At multivariate analyses, the likelihood of adopting shared decision making increased in patients with higher levels of interpersonal relationships' skills (p < 0.05) and global functioning (p < 0.01). On the contrary, being a trainee in psychiatry reduced the likelihood of adopting shared CDM (p < 0.008). Shared decision making has been adopted mainly when patients have a better functioning and less severe clinical symptomatology and by less trained clinicians, differently from national and international recommendations. More efforts should be made to implement interventions to promote shared CDM, with a specific focus for trainees in psychiatry.
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According to the CEDAR multicenter study, SDM is adopted only when patients present a good level of personal and social functioning and when professionals have long-term experience in working in the mental health field.
“According to the CEDAR multicenter study, SDM is adopted only when patients present a good level of personal and social functioning and when professionals have a long-term experience in working in the mental health field [5].”
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 [5]
Cites
Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., & Erikson, P. (2005) · Value in Health · doi:10.1111/j.1524-4733.2005.04054.x · Cited by 5,521 · see citing works
Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes
Shay, L. A., & Lafata, J. E. (2015) · Medical Decision Making · doi:10.1177/0272989x14551638 · Cited by 1,214 · see citing works
Application and Results of the Manchester Short Assessment of Quality of Life (Mansa)
Priebe, S., Huxley, P., Knight, S., & Evans, S. (1999) · International Journal of Social Psychiatry · doi:10.1177/002076409904500102 · Cited by 1,071 · see citing works
A Brief Mental Health Outcome Scale
Jones, S. H., Thornicroft, G., Coffey, M., & Dunn, G. (1995) · The British Journal of Psychiatry · doi:10.1192/bjp.166.5.654 · Cited by 1,019 · 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
Gravel, K., Légaré, F., & Graham, I. D. (2006) · Implementation Science · doi:10.1186/1748-5908-1-16 · Cited by 755 · see citing works
Chisholm, D., Knapp, M. R. J., Knudsen, H. C., Amaddeo, F., Gaite, L., van Wijngaarden, B., & EPSILON Study Group (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.39.s28 · Cited by 480 · see citing works
Implementing shared decision making in routine mental health care
Slade, M. (2017) · World Psychiatry · doi:10.1002/wps.20412 · Cited by 422 · see citing works
Self-citationAttitudes Toward Antipsychotic Medication
Day, J. C., Bentall, R. P., Roberts, C., Randall, F., Rogers, A. E., Cattell, D., Healy, D., Rae, P., & Power, C. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.7.717 · Cited by 360 · see citing works
Oliver, J., Huxley, P. J., Priebe, S., & Kaiser, W. (1997) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/bf00788924 · Cited by 331 · see citing works
Patient involvement in treatment decision-making: The case for a broader conceptual framework
Entwistle, V. A., & Watt, I. S. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.05.002 · Cited by 316 · see citing works
Do Patients With Schizophrenia Wish to Be Involved in Decisions About Their Medical Treatment?
Hamann, J., Cohen, R., Leucht, S., Busch, R. M., & Kissling, W. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.12.2382 · Cited by 254 · see citing works
Szmukler, G. (2019) · World Psychiatry · doi:10.1002/wps.20584 · Cited by 213 · 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
Seale, 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
Chong, W. W., Aslani, P., & Chen, T. F. (2013) · Journal of Interprofessional Care · doi:10.3109/13561820.2013.785503 · Cited by 125 · see citing works
Shared decision-making and outcomes in type 2 diabetes: A systematic review and meta-analysis
Kashaf, M. S., McGill, E., & Berger, Z. D. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.06.030 · Cited by 118 · 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
Decision making in recovery-oriented mental health care.
Matthias, M. S., Salyers, M. P., Rollins, A. L., & Frankel, R. M. (2012) · Psychiatric Rehabilitation Journal · doi:10.2975/35.4.2012.305.314 · Cited by 105 · see citing works
Farrelly, S. E., Lester, H. E., Rose, D. S., Birchwood, M. J., Marshall, M., Waheed, W., Henderson, R. C., SZMUKLER, G. I., & Thornicroft, G. (2015) · Health Expectations · doi:10.1111/hex.12368 · Cited by 105 · see citing works
Adapting 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
Clinical decision making in psychiatry by psychiatrists
Bhugra, D., Easter, A., Mallaris, Y., & Gupta, S. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01737.x · Cited by 81 · see citing works
Puschner, B., Becker, T. M., Mayer, B., Jordan, H., Maj, M., Fiorillo, A., Égerházi, A., Ivánka, T., Munk‐Jørgensen, P., Bording, M. K., et al. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s204579601400078x · Cited by 69 · see citing works
Self-citationCuevas, C. D. L., & Peñate, W. (2013) · Acta Neuropsychiatrica · doi:10.1017/neu.2014.21 · Cited by 59 · see citing works
Carrà, G., Johnson, S., Crocamo, C., Angermeyer, M. C., Brugha, T. S., Azorin, J., Toumi, M., & Bebbington, P. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.03.038 · Cited by 58 · see citing works
Larkin, A., & Hutton, P. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.116.193458 · Cited by 57 · see citing works
Communication and decision-making in mental health: A systematic review focusing on Bipolar disorder
Fisher, A. C., Manicavasagar, V. L., Kiln, F., & Juraskova, I. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.02.011 · Cited by 53 · see citing works
Shared decision making in mental health: the importance for current clinical practice
Alguera-Lara, V., Dowsey, M. M., Ride, J., Kinder, S., & Castle, D. (2017) · Australasian Psychiatry · doi:10.1177/1039856217734711 · Cited by 51 · see citing works
Puschner, B., Steffen, S., Slade, M., Kaliniecka, H., Maj, M., Fiorillo, A., Munk‐Jørgensen, P., Larsen, J. I., Égerházi, A., Nemes, Z., et al. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-90 · Cited by 51 · see citing works
Self-citationF. T. C. S. G., Puschner, B., Neumann, P., Jordan, H., Slade, M., Fiorillo, A., Giacco, D., Égerházi, A., Ivánka, T., Bording, M. K., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-48 · Cited by 44 · see citing works
Self-citationHenderson, C., Farrelly, S. E., Moran, P., Borschmann, R., Thornicroft, G., Birchwood, M. J., Crimson, T., Joshua, J., & Groups, S. (2015) · World Psychiatry · doi:10.1002/wps.20256 · Cited by 39 · see citing works
Empowerment and satisfaction in a multinational study of routine clinical practice
Clarke, E., Puschner, B., Jordan, H., Williams, P. R., Konrad, J., Kawohl, W., Bär, A. S., Wulf Rössler, A., Vecchio, V. D., Sampogna, G., et al. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12365 · Cited by 37 · see citing works
Self-citationBär Deucher, A., Hengartner, M., Kawohl, W., Konrad, J., Puschner, B., Clarke, E., Slade, M., Del Vecchio, V., Sampogna, G., Égerházi, A., et al. (2016) · European Psychiatry · doi:10.1016/j.eurpsy.2016.02.001 · Cited by 28 · see citing works
Self-citationLuciano, M., Rosa, C. D., Sampogna, G., Vecchio, V. D., Giallonardo, V., Fabrazzo, M., Catapano, F., Onchev, G., Raboch, J., Mastrogianni, A., et al. (2018) · European Psychiatry · doi:10.1016/j.eurpsy.2018.07.002 · Cited by 27 · see citing works
Self-citationSlade, M., Cahill, S., Kelsey, W., Powell, R., Strathdee, G., & Valiakalayil, A. (2001) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270170017 · Cited by 24 · see citing works
Self-citationDesire for information of people with severe mental illness
The CEDAR study group, Giacco, D., Luciano, M., Vecchio, V. D., Sampogna, G., Slade, M., Clarke, E., Nagy, M., Égerházi, A., Munk‐Jørgensen, P., et al. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0901-5 · Cited by 20 · see citing works
Self-citationShared decision making in mental health care settings: Perspective, purpose and practice
Tse, S. S.-K. (2017) · World Psychiatry · doi:10.1002/wps.20417 · Cited by 14 · see citing works
Psychiatric practice: caring for patients, collaborating with partners, or marketing to consumers?
Stein, D. J. (2017) · World Psychiatry · doi:10.1002/wps.20415 · Cited by 6 · see citing works
Lambert (1996) · doi:10.1002/(sici)1099-0879(199612)3:4
Flagged first, then by citations
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Sorted by citations
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
Self-citationPerceptions 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
Shared 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
Gupta, R., & Ariefdjohan, M. W. (2020) · Journal of Mental Health · doi:10.1080/09638237.2020.1755021 · Cited by 38 · see citing works
Luciano, M., Fiorillo, A., Brandi, C., Vincenzo, M. D., Égerházi, A., Hiltensperger, R., Kawohl, W., Kovacs, A. I., Wulf Rössler, A., Slade, M., et al. (2022) · International Review of Psychiatry · doi:10.1080/09540261.2022.2085507 · Cited by 20 · see citing works
Self-citationHaugom, E. W., Benth, J. Š., Stensrud, B., Ruud, T., Clausen, T., & Landheim, A. S. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05257-y · Cited by 18 · see citing works
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Sampogna, G., Rocca, B. D., Vincenzo, M. D., Catapano, P., Vecchio, V. D., Volpicelli, A., Martiadis, V., Signorelli, M. S., Ventriglio, A., & Fiorillo, A. (2024) · International Review of Psychiatry · doi:10.1080/09540261.2024.2391800 · Cited by 17 · see citing works
Self-citationJansingh, A., Danner, U. N., Hoek, H. W., & Elburg, A. A. V. (2020) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000642 · Cited by 17 · see citing works
de Filippis, R., Aloi, M., Pilieci, A. M., Boniello, F., Quirino, D., Steardo, L., Segura‐Garcìa, C., & Fazio, P. D. (2022) · PubMed Central · doi:10.36131/cnfioritieditore20220408 · Cited by 15 · see citing works
Kuzman, M. R., Slade, M., Puschner, B., Scanferla, E., Bajić, Ž., Courtet, P., Samochowiec, J., Arango, C., Vahip, S., Taube, M., et al. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.2330 · Cited by 13 · see citing works
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Luciano, M., Carmassi, C., & Albert, U. (2022) · Comprehensive approach to psychiatry · doi:10.1007/978-3-030-98301-7_13 · Cited by 6 · see citing works
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Pellegrini, L., & Albert, U. (2024) · Sustainable development goals series · doi:10.1007/978-3-031-70165-8_21 · Cited by 2 · see citing works
Research Progress of Shared Decision-Making in Schizophrenia with Anxiety
Sun, J., Wang, T., Zhao, P., Zhao, Y.-Q., Wang, L., & Ye, F. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s483126 · Cited by 1 · see citing works
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- Authors
- For the CEDAR Study Group, Luciano, M., Sampogna, G., Del Vecchio, V., Loos, S., Slade, M., Clarke, E., Nagy, M., Kovacs, A., Munk-Jørgensen, P., Krogsgaard Bording, M., Kawohl, W., Rössler, W., Puschner, B., & Fiorillo, A.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- University of Nottingham (GB)
- University of Debrecen (HU)
- University of Zurich (CH)
- Universität Ulm (DE)
- Corresponding author
- Luciano, M.
- Venue
- European Archives of Psychiatry and Clinical Neuroscience
- Published
- 2019-06-07
- Volume
- 270
- Issue
- 6
- Pages
- 645-653
- ISSN
- 0003-9373 (ISSN-L)
- 0940-1334
- 1433-8491
- OpenAlex
- W2954090422
- Cited by
- 17
- References
- 39
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 4 · 2020: 4 · 2019: 1
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- Locations
- European Archives of Psychiatry and Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- FP7 Socio-Economic Sciences and Humanities (223290)
- 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
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- shared decision-making, severe mental illness, psychosis, quality of life, social functioning, global functioning, psychiatric trainees, routine mental health care, clinician-patient relationship
- MeSH terms
- Clinical Decision-Making, Decision Making, Shared, Psychosocial Functioning, Adult, Ambulatory Care, Attitude of Health Personnel, Mental Disorders, Europe, Female, Humans, Longitudinal Studies, Male, Mental Health Services, Middle Aged, Professional-Patient Relations, Psychiatry, Psychotic Disorders, Quality of Life, Process Assessment, Health Care, Social Skills
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