The effects of a shared decision-making intervention in primary care of depression: A cluster-randomized controlled trial
Abstract
Objective Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process. Additional research is needed to test the effect of increased patient participation on outcomes. The aim of this study was to assess, if patient participation in decision-making via a shared decision-making intervention leads to improved treatment adherence, satisfaction, and clinical outcome without increasing consultation time.Methods Cluster-randomized controlled intervention study based on physician training and patient-centered decision aid compared to usual care in primary care settings in Südbaden region of Germany. Twenty-three primary care physicians treating 405 patients with newly diagnosed depression were enrolled. Patient involvement was measured with the patient perceived involvement in care scale (PICS) and a patient participation scale (MSH-scale). Patient satisfaction was measured by the CSQ-8 questionnaire. Treatment adherence was evaluated by patient and provider self-report. Depression severity and remission outcomes were assessed with the Brief PHQ-D.Results Physician facilitation of patient participation improved significantly and to a greater extent in the intervention compared to the control group. There was no intervention effect for depression severity reduction. Doctor facilitation of patient participation, patient-rated involvement, and physician assessment of adherence improved only in the intervention group. Patient satisfaction at post-intervention was higher in the intervention group compared to the control group. The consultation time did not differ between groups.Conclusion A shared decision-making intervention was better than usual care for improving patient participation in treatment decision-making, and patient satisfaction without increasing consultation time. Additional research is needed to model causal linkages in the decision-making process in regard to outcomes.Practice implications The study results encourage the implementation of patient participation in primary care of depression.
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The other major source of heterogeneity was Loh 2007 (SMD -0.18; the point estimate favoured the control group).
“The other major source of heterogeneity was Loh 2007 (SMD ‐0.18; ie. the point estimate favoured the control group).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
Of the three studies with continuous outcomes, Loh 2007 accounted for all the heterogeneity, as demonstrated by I2 = 0% with Loh 2007 excluded.
“Of the three studies with continuous outcomes, Loh 2007 accounted for all the heterogeneity, as demonstrated by I2 = 0% with Loh 2007 excluded.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
With Loh 2007 excluded from the analysis, the combined effect on continuous health behaviour outcomes favoured the control group (SMD -0.39, 95% CI -0.68 to -0.09).
“With Loh 2007 excluded from the analysis, the combined effect on continuous health behaviour outcomes Loh 2007favoured the control group Loh 2007 (SMD ‐0.39, 95% CI ‐0.68 to ‐0.09).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
In Loh 2007, intervention patients reported positive effects of intervention in the one satisfaction outcome measured.
“Similarly intervention patients in Krones 2008 and Loh 2007 reported positive effects of intervention in the one outcome they each measured.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
In Loh 2007, there was no difference in adherence to treatment.
“Similarly, Krones 2008 reported less decisional regret in intervention patients; and Loh 2007 found better participation in shared decision making, although they found no difference in adherence to treatment.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
In Loh 2007, intervention providers had better results in one of two consultation process outcomes.
“Similarly, intervention providers had better results in two out of three consultation process outcomes in Krones 2008; and in one of two in Loh 2007.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
In Loh 2007, there was better participation in shared decision making.
“Similarly, Krones 2008 reported less decisional regret in intervention patients; and Loh 2007 found better participation in shared decision making, although they found no difference in adherence to treatment.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
The remaining studies (Glasgow 2004; Krones 2008; Loh 2007) did not find any benefit of intervention on health status.
“The remaining studies (Glasgow 2004; Krones 2008; Loh 2007) did not find any benefit of intervention on health status.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
Allocation concealment was at low risk in Loh 2007 by virtue of the lots being blinded.
“By virtue of the lots being blinded”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Loh 2007
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Physicians' Shared Decision-Making Behaviors in Depression Care
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Consumer Empowerment and Self-Advocacy Outcomes in a Randomized Study of Peer-Led Education
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Shared decision-making interventions for people with mental health conditions
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A Randomized Controlled Clinical Trial of a Patient Decision Aid for Posttraumatic Stress Disorder
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Spot the difference: shared decision-making and supported decision-making in mental health
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Outcome-Relevant Effects of Shared Decision Making
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Training physicians in shared decision-making—Who can be reached and what is achieved?
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Patients’ Understanding of Shared Decision Making in a Mental Health Setting
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Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial
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Shared decision-making in back pain consultations: an illusion or reality?
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What's the Role of Time in Shared Decision Making?
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Self-Stigma and Consumer Participation in Shared Decision Making in Mental Health Services
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The Choice Project: peer workers promoting shared decision making at a youth mental health service
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How Much Shared Decision Making Occurs in Usual Primary Care of Depression?
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The assessment of satisfaction with care in the perinatal period
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General practice-based clinical trials in Germany - a problem analysis
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- Authors
- Loh, A., Simon, D., Wills, C. E., Kriston, L., Niebling, W., & Härter, M.
- Affiliations
- University Medical Center Freiburg (DE)
- Michigan State University (US)
- Corresponding author
- Loh, Andreas
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 67
- Issue
- 3
- Pages
- 324-332
- ISSN
- 0738-3991 (ISSN-L)
- OpenAlex
- W1995424800
- Cited by
- 382
- References
- 48
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 21 · 2023: 20 · 2022: 17 · 2021: 26 · 2020: 21 · 2019: 22 · 2018: 25 · 2017: 27 · 2016: 27 · 2015: 18 · 2014: 31 · 2013: 24 · 2012: 25
- FWCI
- 25.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- 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 › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- shared decision-making, depression, primary care, patient participation, patient-centered care, decision aids, physician training, medication adherence, patient satisfaction, depression severity, remission, consultation time
- MeSH terms
- Adult, Analysis of Variance, Cooperative Behavior, Decision Making, Decision Support Techniques, Depressive Disorder, Female, Germany, Humans, Male, Middle Aged, Patient Compliance, Patient Participation, Physician-Patient Relations, Physicians, Family, Primary Health Care, Surveys and Questionnaires, Severity of Illness Index, Time Factors, Cluster Analysis, Patient Satisfaction, Outcome Assessment, Health Care, Patient-Centered Care
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