title: Systematic synthesis of barriers and facilitators to service user-led care planning.
abstract: BACKGROUND
  Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.
  
  
  OBJECTIVE
  To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.
  
  
  METHODS
  Systematic evidence synthesis.
  
  
  RESULTS
  Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.
  
  
  CONCLUSIONS
  Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.
authors.affiliation: Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK penny.bee@manchester.ac.uk.
authors.forename: Penny
authors.initials: P
authors.lastname: Bee
authors.affiliation: Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Price
authors.affiliation: Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: John
authors.initials: J
authors.lastname: Baker
authors.affiliation: Penny Bee, PhD, Owen Price, MSc, John Baker, PhD, Karina Lovell, PhD, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
mesh_terms: D002755:Choice Behavior; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction