Feasibility and efficacy of shared decision making for first-admission schizophrenia: a randomized clinical trial.
The feasibility of shared decision making (SDM) for patients with schizophrenia remains controversial due to the assumed inability of patients to cooperate in treatment decision making. This study evaluated the feasibility and efficacy of SDM in patients upon first admission for schizophrenia.



This was a randomized, parallel-group, two-arm, open-label, single-center study conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. Patients with the diagnosis of schizophrenia upon their first admission were randomized into a SDM intervention group or a usual treatment group in a 1:1 ratio. The primary outcome was patient satisfaction at discharge. The secondary outcomes were attitudes toward medication at discharge and treatment continuation at 6 months after discharge.



Twenty-four patients were randomly assigned. The trial was prematurely terminated due to slow enrollment. At discharge, the mean score on satisfaction was 23.7 in the SDM group and 22.1 in the usual care group (unadjusted mean difference: 1.6; 95% CI: -5.2 to 2.0). Group differences were not observed in attitude toward medication and treatment continuation. There was no statistically significant difference between the groups for the mean Global Assessment of Functioning score at discharge or length of stay as safety endpoint.



No statistical differences were found between the SDM group and usual care group in the efficacy outcomes and safety endpoints. Large trials are needed to confirm the efficacy of the SDM program upon first admission for schizophrenia.



The study has been registered with ClinicalTrials.gov as NCT01869660 (registered 27 May, 2013).
Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Mio
M
Ishii
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 1-5-11 Nishishimbashi, Minato-ku, Tokyo, 105-0003, Japan. yokumura@blue.zero.jp.
Yasuyuki
0000-0001-5851-8919
Y
Okumura
Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka, 410-8575, Japan.
Naoya
N
Sugiyama
Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka, 410-8575, Japan.
Hana
H
Hasegawa
Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka, 410-8575, Japan.
Toshie
T
Noda
Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Yoshio
Y
Hirayasu
Department of Social Psychiatry, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan.
Hiroto
H
Ito
D000328:Adult; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011567:Psychiatric Department, Hospital; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology
Inpatient treatment; Pilot study; Randomized controlled trial; SDM; Schizophrenia; Shared decision making