title: Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis.
abstract: In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.
  
  
  
  To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis.
  
  
  
  We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.
  
  
  
  We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09-0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15-18 months (3 RCTs; RR = 0.59, 95% CI 0.35-1.02), with a number needed to treat of approximately 10 (95% CI 5-∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous.
  
  
  
  For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required.
authors.affiliation: Diana Stovell, ClinPsyD, Anthony P. Morrison, ClinPsyD, Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Manchester; Margarita Panayiotou, PhD, Paul Hutton, ClinPsyD, Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Stovell
authors.affiliation: Diana Stovell, ClinPsyD, Anthony P. Morrison, ClinPsyD, Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Manchester; Margarita Panayiotou, PhD, Paul Hutton, ClinPsyD, Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Morrison
authors.affiliation: Diana Stovell, ClinPsyD, Anthony P. Morrison, ClinPsyD, Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Manchester; Margarita Panayiotou, PhD, Paul Hutton, ClinPsyD, Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Margarita
authors.initials: M
authors.lastname: Panayiotou
authors.affiliation: Diana Stovell, ClinPsyD, Anthony P. Morrison, ClinPsyD, Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Manchester; Margarita Panayiotou, PhD, Paul Hutton, ClinPsyD, Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK paul.hutton.cf@ed.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Hutton
mesh_terms: D003657:Decision Making; D006801:Humans; D010358:Patient Participation; D011618:Psychotic Disorders / Q000628:therapy*