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Cited by 110Patient-Provider Communication in HealthcareSchizophrenia research and treatmentMedication Adherence and Compliance

The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review

Open access
Fiorillo, Andrea, Barlati, Stefano, Bellomo, Antonello, Corrivetti, Giulio, Nicolò, Giuseppe, Sampogna, Gaia, Stanga, Valentina, Veltro, Franco +2 more·2020·Annals of General Psychiatry
DOI 10.1186/s12991-020-00293-4PMC PMC7409631
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Abstract

Shared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists. The present paper is a critical appraisal of recent literature on the impact of SDM in improving adherence to pharmacological treatments and in implementing the use of LAIs in the treatment of patients with schizophrenia. SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery. When considering drug treatments, clinicians must evaluate the patient’s preferences, expectations and concerns towards the development of a personalized treatment strategy. Moreover, an active involvement in the decision process could reduce the patient’s perception of being coerced into the use of LAIs. Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team. SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve.

AI snapshot

Written from the paper’s full text.

TL;DR

This clinical review argues that shared decision-making (SDM) is a promising strategy for improving collaboration, treatment engagement, and acceptance of long-acting injectable antipsychotics (LAIs) in schizophrenia, but evidence for improved pharmacological adherence remains mixed. It summarizes eight intervention studies and concludes that short-term benefits are encouraging while long-term, routine-care, and cost-effectiveness data are still lacking.

Key findings

  • SDM is presented as useful for personalized treatment planning and for reducing perceived coercion around LAIs, but adherence effects are inconsistent: a German RCT (Hamann et al., N = 264) found increased participation preferences and wish for more responsibility, with no differences in treatment adherence at 6 and 12 months; a Japanese RCT (Ishii et al., N = 24) found higher treatment satisfaction but no differences in attitude toward medication, treatment continuation, or global functioning.
  • In the PRELAPSE recruitment phase (Kane et al.), 91% of patients accepted at least one LAI antipsychotic during the first 3 months when clinicians received training on non-adherence, LAI effectiveness, SDM principles, and communication strategies.
  • The web-based MyCHOIS–CommonGround intervention (Finnerty et al., N = 1416) was associated with higher engagement in outpatient mental health services; the Discussion states no significant differences were found in antipsychotic adherence, although Table 1 reports higher adherence to antipsychotic medication.
  • Contextual figures include that only 15–28% of US patients with schizophrenia receive a LAI, only 40% of European clinicians would use LAIs for first-episode psychosis, and the CEDAR study found SDM adopted only when patients had good personal/social functioning and professionals had long-term mental health experience.

Methods

  • Clinical review/critical appraisal based on searches of MEDLINE, ISI Web of Knowledge—Web of Science Index, Cochrane Reviews Library, and PsychoINFO using keywords including “shared decision making,” “schizophrenia,” “adherence,” and “long-acting injectable antipsychotic.”
  • Search limited to English, peer-reviewed papers published 2009–2019; reference lists of included papers and recent international schizophrenia guidelines were also searched.
  • Randomized-controlled trials, quasi-experimental studies, and pilot studies were included; eight studies are summarized in Table 1 and synthesized narratively.

Limitations

  • Stated in the paper: results are preliminary and only short-term efficacy has been confirmed; short follow-ups limit data on stability and maintenance of effects; feasibility, cost-effectiveness, and usefulness in crisis situations are unclear; app-based tools require specific skills and may only suit patients with high functioning and less severe symptomatology.
  • Evident from the text: included studies are small and heterogeneous in sample size, target group, decision-support tool, and follow-up (e.g., N = 24, 47, 60, 61, 72), and the review is not a systematic review or meta-analysis.
  • Evident from the text: there is inconsistent reporting for Finnerty et al., with Table 1 stating higher antipsychotic adherence while the Discussion states no significant differences in adherence rate.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12991-020-00293-4

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 102 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    In the United States, only 15-28% of patients with schizophrenia receive a LAI.

    “In the United States only 15–28% of patients with schizophrenia receive a LAI [30, 31].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] Isohanni M, Miettunen J, Jääskeläinen E, Moilanen J, Hulkko A, Huhtaniska S. Under-utilized opportunities to optimize medication management in long-term treatment of schizophrenia. World Psychiatry. 2018;17(2):172–3. source

      Not checked in the free run.

    • cites [31] Offord S, Wong B, Mirski D, Baker RA, Lin J. Healthcare resource usage of schizophrenia patients initiating long-acting injectable antipsychotics vs oral. J Med Econ. 2013;16(2):231–9. source

      Not checked in the free run.

  • Premisecitation

    In schizophrenia and psychotic disorders, adherence to pharmacological treatments is frequently far from optimal.

    “These latter aspects related to adherence are especially relevant in the setting of schizophrenia and psychotic disorders, where adherence to pharmacological treatments is frequently far from optimal and represents the main cause of relapse [16–18] and hospitalizations [19, 20].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [16] Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry. 2018;17(2):149–60. source

      Not checked in the free run.

    • cites [17] Emsley R. Antipsychotic maintenance treatment in schizophrenia and the importance of preventing relapse. World Psychiatry. 2018;17(2):168–9. source

      Not checked in the free run.

    • cites [18] Howes OH, Kaar SJ. Antipsychotic drugs: challenges and future directions. World Psychiatry. 2018;17(2):170–1. source

      Not checked in the free run.

    • cites [19] Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry. 2018;17(1):12–23. source

      Not checked in the free run.

    • cites [20] Stevens GL, Dawson G, Zummo J. Clinical benefits and impact of early use of long-acting injectable antipsychotics for schizophrenia. Early Interv Psychiatry. 2016;10(5):365–77. source

      Not checked in the free run.

  • Premisecitation

    Shared decision-making translates into more efficient allocation of healthcare resources.

    “Furthermore, this has also translated in more efficient allocation of healthcare resources [13–15].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [13] Foot C, Gilburt H, Dunn P. People in control of their own health and care: the state of involvement. London: King’s Fund; 2014.

      Not checked in the free run.

    • cites [14] Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O’Brien RW, Tomoyasu N, Pincus HA. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry. 2018;17(1):30–8. source

      Not checked in the free run.

    • cites [15] Priebe S, Miglietta E. Assessment and determinants of patient satisfaction with mental health care. World Psychiatry. 2019;18(1):30–1. source

      Not checked in the free run.

  • Interpretationcitation

    In the TEMPO training, long-term effectiveness of the intervention was associated with the inclusion of a dedicated session (4-step approach) on SDM in patients with psychosis aimed at changing the patient decision-making style.

    “In the case of the TEMPO training [40], long-term effectiveness of the intervention was associated with the inclusion of a dedicated session (4-step approach) on SDM in patients with psychosis aimed at changing the patient decision-making style.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] McCabe R, John P, Dooley J, Healey P, Cushing A, Kingdon D, Bremner S, Priebe S. Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial. Br J Psychiatry. 2016;209(6):517–24. source

      Not checked in the free run.

  • Interpretationcitation

    All experimental interventions specifically addressed to patients resulted in a more active behavior during psychiatric consultations within the hospitalization period.

    “all experimental interventions specifically addressed to patients [38, 39, 44, 45] resulted in a more active behavior during psychiatric consultations within the hospitalization period.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [38] Hamann J, Mendel R, Meier A, Asani F, Pausch E, Leucht S, Kissling W. “How to speak to your psychiatrist”: shared decision-making training for in patients with schizophrenia. Psychiatr Serv. 2011;62:1218–21. source

      Not checked in the free run.

    • cites [39] An SY, Kim GH, Kim JY. Effectiveness of shared decision-making training program in people with schizophrenia in South Korea. Perspect Psychiatr Care. 2017;53(2):111–8. source

      Not checked in the free run.

    • cites [44] Finnerty MT, Layman DM, Chen Q, Leckman-Westin E, Bermeo N, Ng-Mak DS, Rajagopalan K, Hoagwood KE. Use of a web-based shared decision-making program: impact on ongoing treatment engagement and antipsychotic adherence. Psychiatr Serv. 2018;69(12):1215–21. source

      Not checked in the free run.

    • cites [45] Ishii M, Okumura Y, Sugiyama N, Hasegawa H, Noda T, Hirayasu Y, Ito H. Efficacy of shared decision making on treatment satisfaction for patients with first-admission schizophrenia: study protocol for a randomised controlled trial. BMC Psychiatry. 2014;14:111. source

      Not checked in the free run.

  • May combine two claims. 26
  • Classified as probably not a substantial claim. 19

  • May combine two claims.

    Findingown data

    Based on the eight studies included in this literature review, interventions focused on enhancement of the adoption of SDM in clinical routine care seem promising, although results are preliminary and only short-term efficacy has been confirmed.

    “Based on the results of the eight studies included in this literature review, interventions focused on enhancement of the adoption in SDM in the clinical routine care seem promising, although these results are preliminary and only the short-term efficacy of these approaches has been confirmed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The interventions proposed appear feasible and well-accepted by both patients and clinicians.

    “The interventions proposed appear feasible and well-accepted by both patients and clinicians”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    SDM has a positive impact on patients' satisfaction and adherence to treatments, as well as on quality of life and empowerment.

    “studies have demonstrated that it has a positive impact on the patient’s levels of satisfaction and adherence to treatments, as well as on his/her quality of life and empowerment [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Matthias MS, Salyers MP, Rollins AL, Frankel RM. Decision making in recovery-oriented mental health care. Psychiatr Rehabil. 2012;35:305–14. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with severe mental disorders report a greater desire to be involved in clinical decision-making and a need to have a say in the process of care than individuals receiving assistance for other medical conditions.

    “This has been especially highlighted in the case of patients with severe mental disorders who report a greater desire of being involved in clinical decision-making and a need to have a say in the process of care, as compared to individuals receiving assistance for other medical conditions [8–11].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [8] Bär Deucher A, Hengartner MP, Kawohl W, Konrad J, Puschner B, Clarke E, Slade M, Del Vecchio V, Sampogna G, Égerházi A, Süveges Á, Krogsgaard Bording M, Munk-Jørgensen P, Rössler W, CEDAR study group. Participation in medical decision-making across Europe: an international longitudinal multicenter study. Eur Psychiatry. 2016;35:39–46. source

      Not checked in the free run.

    • cites [9] Loos S, Arnold K, Slade M, Jordan H, Del Vecchio V, Sampogna G, Süveges Á, Nagy M, Krogsgaard Bording M, Østermark Sørensen H, Rössler W, Kawohl W, Puschner B, CEDAR study group. Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach. Soc Psychiatry Psychiatr Epidemiol. 2015;50:363–70. source

      Not checked in the free run.

    • cites [10] O’Sullivan M-J, Rae S. Shared decision-making in psychiatric medicines management. Mental Health Practice. 2014;17:16–22. source

      Not checked in the free run.

    • cites [11] Zimmerman M, Morgan TA, Stanton K. The severity of psychiatric disorders. World Psychiatry. 2018;17(3):258–75. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review's literature search used specified keywords in MEDLINE, ISI Web of Knowledge-Web of Science Index, Cochrane Reviews Library and PsychoINFO.

    “The present review was based on search of key words “shared decision making”, “intervention”, “schizophrenia”, “psychosis”, “schizophrenia spectrum disorder” matched with “adherence”, “intervention”, “training”, “long-acting injectable antipsychotic”, “LAI” in the main databases MEDLINE, ISI Web of Knowledge—Web of Science Index, Cochrane Reviews Library and PsychoINFO.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In Europe, only 40% of clinicians would use LAIs for treating first-episode psychosis, and a large portion tend to use LAIs only in patients with long-term disease and poor compliance.

    “In Europe only 40% of clinicians would use LAIs for treating first-episode psychosis [32], while a large portion of them tend to use LAIs only in the case of patients with long-term disease and poor compliance [33, 34].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [32] Geerts P, Martinez G, Schreiner A. Attitudes towards the administration of long-acting antipsychotics: a survey of physicians and nurses. BMC Psychiatry. 2013;13:58. source

      Not checked in the free run.

    • cites [33] Potkin S, Bera R, Zubek D, Lau G. Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia. BMC Psychiatry. 2013;13:261. source

      Not checked in the free run.

    • cites [34] Sajatovic M, Ross R, Legacy SN, Correll CU, Kane JM, Di Biasi F, Fitzgerald F, Byerly M. Identifying patients and clinical scenarios for use of long-acting injectable antipsychotics-expert consensus survey part 1. Neuropsychiatr Dis Treat. 2018;14:1463–74. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The review considered papers published between 2009 and 2019, limited to English and peer-reviewed journals.

    “The search considered recent papers published between 2009 and 2019, as publications from previous years had already been covered by Duncan et al. [37]. The search was limited to papers in English and published in peer-reviewed journals.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Duncan E, Best C, Hagen S. Shared decision making interventions for people with mental health conditions. Cochrane Database Syst Rev. Art. No. CD007297; 2010. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Recommendations on LAI use in routine care differ between guidelines, and LAI use remains limited despite proved efficacy on long-term patient management.

    “yet recommendations on their use in the clinical routine care differ from one guideline to another, and their current use is still limited despite their proved efficacy on long-term patient management [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M. Guidelines for the pharmacotherapy of schizophrenia in adults. Can J Psychiatry. 2017;62(9):604–16. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A number of studies have proven the effectiveness, safety and tolerability of LAIs.

    “Currently, a number of studies have proven the effectiveness, safety and tolerability of LAIs [25]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Correll CU, Citrome L, Haddad PM, Lauriello J, Olfson M, Calloway SM, Kane JM. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. J Clin Psychiatry. 2016;77(suppl 3):1–24. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review checked reference lists of all included papers to identify further relevant papers.

    “The references’ lists of all included papers have been carefully searched in order to identify further papers relevant for the review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Shared decision-making increases adherence to prescribed treatment and improves long-term outcomes.

    “In fact, shared process has proven to increase adherence to the prescribed treatment and improve long-term outcomes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] Foot C, Gilburt H, Dunn P. People in control of their own health and care: the state of involvement. London: King’s Fund; 2014.

      Not checked in the free run.

    • cites [14] Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O’Brien RW, Tomoyasu N, Pincus HA. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry. 2018;17(1):30–8. source

      Not checked in the free run.

    • cites [15] Priebe S, Miglietta E. Assessment and determinants of patient satisfaction with mental health care. World Psychiatry. 2019;18(1):30–1. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients receiving shared decision-making training reported higher participation preferences and increased desire to have more responsibility in treatment decisions, which continued at 6-month follow-up.

    “Patients receiving the shared decision-making training reported higher participation preferences and increased patients’ desire to have more responsibility in treatment decisions, which continued at 6-month follow-up”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Hamann J, Mendel R, Meier A, Asani F, Pausch E, Leucht S, Kissling W. “How to speak to your psychiatrist”: shared decision-making training for in patients with schizophrenia. Psychiatr Serv. 2011;62:1218–21. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Discrepancies between the two evaluators in study selection were solved through discussion with a senior expert researcher.

    “In case of discrepancies between the two evaluators in the study selection, these were solved through discussion with a senior expert researcher.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The review included randomized-controlled trials, quasi-experimental studies, and pilot studies.

    “Randomized-controlled trials, quasi-experimental studies, and pilot studies were included in the review in order to provide an updated overview on the topic, as extensive as possible.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] 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, CEDAR Study Group. When does shared decision making is adopted in psychiatric clinical practice? Results from a European multicentric study. Eur Arch Psychiatry Clin Neurosci. 2019. https://doi.org/10.1007/s00406-019-01031-y. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In schizophrenia and psychotic disorders, poor adherence to pharmacological treatments is the main cause of relapse and hospitalizations.

    “These latter aspects related to adherence are especially relevant in the setting of schizophrenia and psychotic disorders, where adherence to pharmacological treatments is frequently far from optimal and represents the main cause of relapse [16–18] and hospitalizations [19, 20].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [16] Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry. 2018;17(2):149–60. source

      Not checked in the free run.

    • cites [17] Emsley R. Antipsychotic maintenance treatment in schizophrenia and the importance of preventing relapse. World Psychiatry. 2018;17(2):168–9. source

      Not checked in the free run.

    • cites [18] Howes OH, Kaar SJ. Antipsychotic drugs: challenges and future directions. World Psychiatry. 2018;17(2):170–1. source

      Not checked in the free run.

    • cites [19] Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry. 2018;17(1):12–23. source

      Not checked in the free run.

    • cites [20] Stevens GL, Dawson G, Zummo J. Clinical benefits and impact of early use of long-acting injectable antipsychotics for schizophrenia. Early Interv Psychiatry. 2016;10(5):365–77. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    SDM is an interesting approach to achieve greater knowledge of LAIs and acceptance on behalf of patients and families.

    “In such scenario, SDM is certainly an interesting approach to achieve greater knowledge of LAIs and acceptance on behalf of patients and families [35, 36].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [35] Kane JM, Schooler NR, Marcy P, Achtyes ED, Correl CU, Robinson DG. Patients with early-phase schizophrenia will accept treatment with sustained-release medication (long-acting injectable antipsychotics): results from the recruitment phase of the PRELAPSE trial. J Clin Psychiatry. 2019;80:3.

      Not checked in the free run.

    • cites [36] Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res. 2015;225(1–2):14–30. source

      Not checked in the free run.

    • Rests on an assumption: Patients can have prejudices and unjustified fears related to the LAI formulation.
    • Rests on an assumption: Routine use of LAIs is delayed by patients’ attitudes towards the drug, the perception that LAIs are imposed punitively or coercively, previous negative experience with LAIs, or negative perception of LAIs by family members.

  • May combine two claims.

    Premisecitation

    Although SDM has been repeatedly advocated as the preferred style in routine clinical practice, its dissemination in ordinary settings is not satisfying.

    “Although SDM has been repeatedly advocated as the preferred style in routine clinical practice, its dissemination in ordinary settings is not satisfying.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The advent of LAIs appeared to overcome poor adherence but did not solve the widespread lack of adherence because LAIs remain largely underutilized.

    “The advent of new long-acting injectable antipsychotics (LAIs) had appeared to overcome the issue of poor adherence [21–24], but did not solve the widespread lack of adherence, as these drugs still remain largely underutilized.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [21] Fava M. The promise and challenges of drug repurposing in psychiatry. World Psychiatry. 2018;17(1):28–9. source

      Not checked in the free run.

    • cites [22] Fleischhacker WW. The long-term treatment of schizophrenia with antipsychotics: a perennial debate. World Psychiatry. 2018;17:169–70. source

      Not checked in the free run.

    • cites [23] Pompili M, Giordano G, Luciano M, Lamis DA, Del Vecchio V, Serafini G, Sampogna G, Erbuto D, Falkai P, Fiorillo A. Unmet needs in schizophrenia. CNS Neurol Disord Drug Targets. 2017;16(8):870–84.

      Not checked in the free run.

    • cites [24] Samalin L, Garnier M, Auclair C, Llorca PM. Clinical decision-making in the treatment of schizophrenia: focus on long-acting injectable antipsychotics. Int J Mol Sci. 2016;17(11):1935. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Another issue is the feasibility of these interventions in clinical routine care, their cost-effectiveness and their usefulness in managing crisis situations.

    “Another issue is the feasibility of these interventions in the clinical routine care, their cost-effectiveness and their usefulness in managing crisis situations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    When patients are involved in choices about their own health and care, they ponder options carefully and are most likely to appreciate the value of proposed treatment and to agree to treatment with a favorable attitude.

    “When patients are involved in choices about their own health and care, they ponder options carefully and are most likely to appreciate the value of proposed treatment, to agree to treatment with a favorable attitude.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery.

    “SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    An active involvement in the decision process could reduce the patient's perception of being coerced into the use of LAIs.

    “Moreover, an active involvement in the decision process could reduce the patient’s perception of being coerced into the use of LAIs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients can have prejudices and unjustified fears related to the LAI formulation.

  • May combine two claims.

    Premisecitation

    The MyCHOIS-CommonGround intervention was cost-effective, making it particularly suitable for attaining long-term outcomes in patients with severe mental disorders.

    “Another noticeable advantage was the cost-effectiveness of the intervention which makes it particularly suitable for attaining long-term outcomes in patients with severe mental disorders [46–50]”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [46] Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry. 2019;18(1):20–8. source

      Not checked in the free run.

    • cites [47] Firth J, Torous J, Stubbs B, Firth JA, Steiner GZ, Smith L, Alvarez-Jimenez M, Gleeson J, Vancampfort D, Armitage CJ, Sarris J. The “online brain”: how the Internet may be changing our cognition. World Psychiatry. 2019;18(2):119–29. source

      Not checked in the free run.

    • cites [48] Linardon J, Cuijpers P, Carlbring P, Messer M, Fuller-Tyszkiewicz M. The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials. World Psychiatry. 2019;18(3):325–36. source

      Not checked in the free run.

    • cites [49] Salyers MP, Fukui S, Bonfils KA, Firmin RL, Luther L, Goscha R, Rapp CA, Holter MC. Consumer outcomes after implementing common ground as an approach to shared decision making. Psychiatr Serv. 2017;68(3):299–302. source

      Not checked in the free run.

    • cites [50] Torous J, Andersson G, Bertagnoli A, Christensen H, Cuijpers P, Firth J, Haim A, Hsin H, Hollis C, Lewis S, Mohr DC, Pratap A, Roux S, Sherrill J, Arean PA. Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry. 2019;18(1):97–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if there is no constant work of comparison and communication with the reference psychiatric team.

    “Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team.”
    • Also stated in: § Suggestions for clinical practice · plain
      “Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Patients treated by psychiatrists receiving TEMPO training reported a more positive therapeutic relationship, as did psychiatrists.

    “Patients treated by psychiatrists receiving the TEMPO training reported a more positive therapeutic relationship as did psychiatrists”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] McCabe R, John P, Dooley J, Healey P, Cushing A, Kingdon D, Bremner S, Priebe S. Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial. Br J Psychiatry. 2016;209(6):517–24. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A positive impact was found on service users' and care coordinators' confidence to explore medication experience, and group-based training was valued.

    “A positive impact was found on service users’ and care coordinators confidence to explore medication experience, and group-based training was valued”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Ramon S, Morant N, Stead U, Perry B. Shared decision-making for psychiatric medication: a mixed-methods evaluation of a UK training programme for service users and clinicians. Int J Soc Psychiatry. 2017;63(8):763–72. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Resolving resistances to LAIs could lead to more patients benefitting from LAIs.

    “Resolving such resistances hence could lead to more patients benefitting from LAIs.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Routine use of LAIs is delayed by patients’ attitudes towards the drug, the perception that LAIs are imposed punitively or coercively, previous negative experience with LAIs, or negative perception of LAIs by family members.

  • May combine two claims.

    Premisecitation

    Patients receiving the SDM training program reported improvement in levels of self-esteem, problem-solving ability, and quality of life compared to control.

    “Patients receiving the SDM training program report an improvement in the levels of self-esteem, problem-solving ability, and quality of life compared to patients allocated in the control group”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] An SY, Kim GH, Kim JY. Effectiveness of shared decision-making training program in people with schizophrenia in South Korea. Perspect Psychiatr Care. 2017;53(2):111–8. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients reported a change in decisional conflict and perceptions of practitioners' interactional style in promoting SDM at follow-up.

    “Patients reported a change in decisional conflict and perceptions of practitioners’ interactional style in promoting SDM at the follow-up.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Ramon S, Morant N, Stead U, Perry B. Shared decision-making for psychiatric medication: a mixed-methods evaluation of a UK training programme for service users and clinicians. Int J Soc Psychiatry. 2017;63(8):763–72. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of LAIs by patients and often also by psychiatrists.

    “Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients can have prejudices and unjustified fears related to the LAI formulation.
    • Rests on an assumption: Routine use of LAIs is delayed by patients’ attitudes towards the drug, the perception that LAIs are imposed punitively or coercively, previous negative experience with LAIs, or negative perception of LAIs by family members.

  • May combine two claims.

    Premisecitation

    At one-year follow-up, patients in the MyCHOIS-CommonGround group reported higher level of engagement in outpatient mental health services and of adherence to antipsychotic medication compared to control.

    “At one-year follow-up, patients in the MyCHOIS–CommonGround report higher level of engagement in outpatient mental health services and of adherence to antipsychotic medication compared to the control group”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Finnerty MT, Layman DM, Chen Q, Leckman-Westin E, Bermeo N, Ng-Mak DS, Rajagopalan K, Hoagwood KE. Use of a web-based shared decision-making program: impact on ongoing treatment engagement and antipsychotic adherence. Psychiatr Serv. 2018;69(12):1215–21. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Hamann J, Parchmann A, Sassenberg N, Bronner K, Albus M, Richter A, Hoppstock S, Kissling W. Training patients with schizophrenia to share decisions with their psychiatrists: a randomized-controlled trial. Soc Psychiatry Psychiatr Epidemiol. 2017;52(2):175–82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The current and future increasing availability of LAIs will enrich the choice for clinicians who intend to use a long-acting formulation.

    “The current and future increasing availability of LAIs will enrich the choice for the clinicians who intend to use a long-acting formulation [67].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Llorca PM, Abbar M, Courtet P, Guillame S, Lancrenon S, Samalin L. Guidelines for the use and management of long-acting injectable antipsychotics in seriuos mental illness. BMC Psychiatry. 2013;13:340. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    SDM is a promising strategy for enhancing collaboration between clinicians and patients, given the complementary knowledge and expertise of both parties.

    “SDM is recognized as a promising strategy for enhancing collaboration between clinicians and patients, given the complementary knowledge and expertise of both parties [52]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Morant N, Kaminskiy E, Ramon S. Shared decision making for psychiatric medication management: beyond the micro-social. Health Expect. 2016;19(5):1002–11. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Psychiatrists generally believe that patients are less willing to accept LAIs than oral treatments and they avoid proposing it.

    “Psychiatrists generally believe that patients are less willing to accept LAIs, than oral treatments and they avoid proposing it [64]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [64] Heres S, Reichhart T, Hamann J, Mendel R, Leucth S, Kissling W. Psychiatrists’ attitude antipsychotic depot treatment in patients with first-episode schizophrenia. Eur Psychiatry. 2011;26:297–301. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Active involvement of the patient in the discussion on the type of formulation to be adopted can be useful to reduce the perceived coercion reported by patients in receiving pharmacological treatments.

    “At the same time, the active involvement of the patient in the discussion on the type of formulation to be adopted can be useful to reduce the perceived coercion reported by patients in receiving pharmacological treatments.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients report feeling pressured or being persuaded or coerced into accepting pharmacological treatments like LAIs if they fail to take their oral prescribed medication.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a qualitative study with young patients with psychosis, patients prefer LAIs because they do not have to remember to take pills every day.

    “In a qualitative study with young patients with psychosis, Das et al. [63] found that patients prefer LAIs, since they do not have to remember to take pills every day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Das AK, Malik A, Haddad PM. A qualitative study of the attitudes of early patients in an early intervention service towards antipsychotic long-acting injections. Ther Adv Psychopharmacol. 2014;4(5):179–85. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patient recovery can be fostered by adopting a SDM style, enhancing empowerment and self-efficacy of patients.

    “Patient recovery can be fostered by adopting a SDM style, enhancing empowerment and self-efficacy of patients [52–55]”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [52] Morant N, Kaminskiy E, Ramon S. Shared decision making for psychiatric medication management: beyond the micro-social. Health Expect. 2016;19(5):1002–11. source

      Not checked in the free run.

    • cites [53] Deegan PE, Rapp C, Holter M, Riefer M. A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric Serv. 2008;59:603–5. source

      Not checked in the free run.

    • cites [54] Goodwin N, Dixon A, Poole T, Raleigh V, Gao H, Lyscom T. Improving the quality of care in general practice. Report of an independent inquiry commissioned by The King’s Fund; 2011.

      Not checked in the free run.

    • cites [55] Vita A, Barlati S. Recovery from schizophrenia: is it possible? Curr Opin Psychiatry. 2018;31(3):246–55. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Considerable resources have been invested to make SDM a routine way of working: computerized programs, role-play techniques, training groups for mental health staff.

    “In recent years, considerable resources have been invested to make the SDM a routine way of working: computerized programs, role-play techniques, training groups for mental health staff [58]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Alguera-Lara V, Dowsey MM, Ride J, Kinder S, Castle D. Shared decision making in mental health: the importance for current clinical practice. Aust Psychiatry. 2017;25(6):578–82. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Medication non-adherence plays an important role in relapse rates, poor outcome, and high costs in schizophrenia.

    “However, the adoption of SDM appears useful in the long-term treatment of patients with schizophrenia where medication non-adherence plays an important role in relapse rates, poor outcome, and high costs [36]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res. 2015;225(1–2):14–30. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    During clinical encounters, the most frequent decisions taken by clinicians were related to medications and to the severity of symptoms.

    “Konrad et al. [56] found that during clinical encounters, the most frequent decisions taken by clinicians were related to medications and to the severity of symptoms”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Konrad J, Loos S, Neumann P, Zentner N, Mayer B, Slade M, Jordan H, De Rosa C, Del Vecchio V, Égerházi A, Nagy M, Bording MK, Sørensen HØ, Kawohl W, Rössler W, Puschner B. Content and implementation of clinical decisions in the routine care of people with severe mental illness. J Ment Health. 2015;24(1):15–9. source

      Not checked in the free run.

42 of 42

  • The paper relies on this without support.

    Patients can have prejudices and unjustified fears related to the LAI formulation.

    “SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve.”

  • The paper relies on this without support.

    Routine use of LAIs is delayed by patients’ attitudes towards the drug, the perception that LAIs are imposed punitively or coercively, previous negative experience with LAIs, or negative perception of LAIs by family members.

    “Finally, the routine use of LAIs is delayed by other issues such as the patients’ attitude towards the drug (the fear of needles or of side-effects), the perception that LAIs are imposed on them in a punitive and coercive manner, or as result of a previous negative experience with LAIs, or in consideration of the negative perception of LAIs by their family members.”

  • The paper relies on this without support.

    Many mental health care professionals consider the matter of medication to be too sensitive to be discussed with the patient and approached by SDM, too time-consuming for them and somewhat discouraging for the patient (in terms of adverse effects).

    “Many mental health care professionals consider the matter of medication to be too sensitive to be discussed with the patient and approached by SDM, too time-consuming for them and somewhat discouraging for the patient (in terms of adverse effects).”

  • The paper relies on this without support.

    Patients prefer a more directive/paternalistic practitioner style during crisis.

    “patients admit preferring a more directive/paternalistic practitioner style during crisis”

  • The paper relies on this without support.

    Patients report feeling pressured or being persuaded or coerced into accepting pharmacological treatments like LAIs if they fail to take their oral prescribed medication.

    “they report also to feel pressured or being persuaded or coerced into accepting pharmacological treatments like LAIs if they fail to take their oral prescribed medication”

  • The paper relies on this without support.

    LAI antipsychotics are better than oral drugs in preventing relapses and re-hospitalizations.

    “Communicate that LAI antipsychotics are better than oral drugs in preventing relapses and re-hospitalizations”

  • The paper relies on this without support.

    A stable therapy is associated with a better outcome.

    “Propose LAI antipsychotics in the early stages of illness, explaining that a stable therapy is associated with a better outcome”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Therapeutic adherence is described as a fluid process that reinforces collaborative approaches between the patient and the clinician and improves the relationship with professionals, affecting satisfaction with treatment.

    “Some articles described therapeutic adherence as a fluid process that reinforces the collaborative approaches between the patient and the clinician [38,56,76] and improves the relationship with professionals [46], affecting satisfaction with treatment [34,45,62,77,78].”

    From Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis (2023) · cites this paper as [56]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • MyCHOIS adherence effect is both affirmed and denied

    Major

    The Results say the MyCHOIS-CommonGround tool was proven effective in improving adherence, but the Discussion says it produced no significant difference in antipsychotic adherence.

  • Outpatient intervention described as producing behavior during hospitalization

    Minor

    The Discussion includes study [44] among interventions said to produce more active behavior during hospitalization, whereas Table 1 places that study in outpatient clinics.

2 of 2

The citation lists haven’t been fetched yet

References 66 · Cited by 110

Research works printed but not linked: 3

  1. Foot C, Gilburt H, Dunn P. People in control of their own health and care: the state of involvement. London: King’s Fund; 2014.
  2. National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: treatment and management. London: NICE; 2014.
  3. Lehman AF, Lieberman JA, Dixon LB, et al. Sterring committee on practice guidelines. Practice guidelines for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161(2 Suppl):1–56.

Authors
Fiorillo, A., Barlati, S., Bellomo, A., Corrivetti, G., Nicolò, G., Sampogna, G., Stanga, V., Veltro, F., Maina, G., & Vita, A.
Affiliations
  • University of Campania "Luigi Vanvitelli" (IT)
  • Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
  • University of Foggia (IT)
  • ASL Roma (IT)
  • University of Brescia (IT)
  • Regione Molise (IT)
  • University of Turin (IT)
Corresponding author
Fiorillo, Andrea
ORCID
Venue
Annals of General Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2020-08-05
Volume
19
Issue
1
Pages
43-43
ISSN
1744-859X (ISSN-L)
DOI
10.1186/s12991-020-00293-4
PMC
PMC7409631
OpenAlex
W3047341401
Semantic Scholar
d6ac968c8f015dce49d3322fa13c8bbe63ee99ff
Cited by
110
References
66
Citations by year
2026: 12 · 2025: 18 · 2024: 23 · 2023: 21 · 2022: 19 · 2021: 13 · 2020: 3 · 2012: 1
FWCI
2.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of General Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders
H. Lundbeck A/S
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords
shared decision-making, schizophrenia, long-acting injectable antipsychotics, medication adherence, patient preferences, patient-clinician communication, treatment acceptance, personalized treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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