Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions

Published date11 September 2017
Pages191-213
Date11 September 2017
DOIhttps://doi.org/10.1108/MHRJ-01-2017-0002
AuthorYaara Zisman-Ilani,Erin Barnett,Juliette Harik,Anthony Pavlo,Maria O’Connell
Expanding the concept of shared decision
making for mental health: systematic
search and scoping review of
interventions
Yaara Zisman-Ilani, Erin Barnett, Juliette Harik, Anthony Pavlo and Maria OConnell
Abstract
Purpose Much of the existing literature on shared decision making (SDM) in mental health has focused on
the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other
essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM
interventions in mental health by identifying important components, in addition to information exchange, that
may contribute to the SDM process in mental health.
Design/methodology/approach The authors conducted a systematic literature search using the
Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health
treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development
paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors
included studies of participants with a mental illness facing a mental health care decision, their caregivers,
and providers.
Findings A final sample of 31 records was systematically selected. Most interventions were developed
and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a
central component of the identified studies, important additional elements were: eliciting patient preferences
and values, providing patient communication skills training, eliciting shared care planning, facilitating patient
motivation, and eliciting patient participation in goal setting.
Originality/value The review indicates that additional elements, other than information exchange such as
sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health.
Future SDM interventions in mental health could consider including techniques that aim to increase patient
involvement in activities such as goal settings, values, and preference clarification, or facilitating patient
motivation, before and after presenting treatment options.
Keywords Intervention, Psychiatry, Mental health, Decision aid, Shared decision making
Paper type Literature review
1. Introduction
Shared decisionmaking (SDM) is a promising approachto promote patient-centeredcare in health
care settings by eliciting greater patient engagement in medical decision making (Barry and
Edgman-Levitan, 2012). The early conceptualization of SDM in medicine included three general
steps: information exchange, deliberation, and reaching a mutually agreed upon decision
(Charles et al.,1997, 1999). Clinicians and researchershave translated this theoreticalSDM model
into operationaltools called decisionaids (DAs) (Stacey et al., 2011; Elwynet al., 2006). These tools
are tailored toa specific health condition, presentinformation on pros and cons of variousoptions,
and encourage patients to consider what matters most to them (Stacey et al., 2014, 2017).
Previous reviews of SDM in mental health have recommended using DAs when discussing
treatment options (Duncan et al.,2010;Hamannet al.,2003).
Received 18 January 2017
Revised 16 May 2017
14 June 2017
Accepted 23 June 2017
The authors of this manuscript
would like to thank Tom Mead
from Dartmouth College
Biomedical Libraries for his time,
effort and help in conducting the
search.
Yaara Zisman-Ilani is an
Assistant Professor at the
Department of Rehabilitation
Sciences, College of Public
Health, Temple University,
Philadelphia, Pennsylvania,
USA.
Erin Barnett is an Assistant
Professor at the Dartmouth
Trauma Interventions Research
Center, Dartmouth-Hitchcock
Medical Center, Geisel School
of Medicine, Lebanon,
New Hampshire, USA.
Juliette Harik is based at the
National Center for PTSD,
White River Junction, Vermont,
USA and Geisel School of
Medicine, Lebanon,
New Hampshire, USA.
Anthony Pavlo is an Associate
Research Scientist at the
Program for Recovery and
Community Health, Yale
University, New Haven,
Connecticut, USA.
Maria OConnell is based at the
Yale University, New Haven,
Connecticut, USA.
DOI 10.1108/MHRJ-01-2017-0002 VOL. 22 NO. 3 2017, pp. 191-213, © Emerald Publishing Limited, ISSN 1361-9322
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MENTALHEALTH REVIEW JOURNAL
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Although DAs reflect important advances in the effort to educate and engage patients in decision
making, they tend to focuson only one element of SDM information exchangeand they do not
specifically target other important components of the SDM process, such as deliberation and
making a shared decision, or, especially important in mental health, building rapport and trust
(Agoritsaset al., 2015). These limitationsare particularly significantin mental health settings in which
patients oftenassume more passive roles in relation to providers(Morant et al., 2015). Considering
that SDM has been advocated as an approach with the potential to support personal recovery,
self-determination, person-centered care, and psychiatric rehabilitation of people with mental
conditions (Drake et al., 2010; Anthony, 2010; Deegan and Drake, 2006), narrowing the idea of
SDM in mental health to the practice of exchanging information or use of DAs overlooks the
possible broadercontribution of SDM to such outcomes (Dixonet al., 2016). Therefore, use of DAs
that focus on the enhancement of observablebehaviors thought to be reflectiveof a SDM process
alone do not guaranteethat patient-centered engagementor true collaboration in decision making
has occurred. Although information exchange is a necessary element in facilitating SDM inmental
health, we believe it is insufficient for the achievement of shared decisions.
The purpose of the present work is to expand the review of SDM interventions in mental health by
exploring diverse interventions that serve to enhance patient engagement in care and identifying
additional components, other than information exchange, that may contribute to the SDM
process in mental health.
2. Methods
2.1 Design
We conducted a systematic literature search with supplementary scoping search of the
literature on SDM in mental health treatment. The supplementary search included published
work that was not retrieved by the systematic search but was thought by the authors to be
important to includ e.
2.2 Eligibility criteria and a working definition of SDM inter vention
To be eligible for inclusion, studies needed to describe (in a conceptual work or development
paper) or evaluate (in any type of research design) a SDM intervention in mental health.
We defined a SDM intervention as one that: involved elements of discussion or communication of
health information between a provider and a patient or a caregiver, and aimed to enhance patient
participation, involvement, or self-determination in decisions about the guiding or planning of
treatment. Studies describing or evaluating DAs and psychoeducational materials were included
only when they involved interaction between patients and providers. We excluded: review
articles; studies that were published before 1990; publications that were in a language other than
English; and studies that surveyed views, perceptions, or attitudes regarding SDM.
2.3 Types of participants
We included studies of participants with a mental illness facing a mental health care decision, their
caregivers, and providers.
2.4 Search strategy
We systematically searched the Ovid-Medline database using the search terms and strategy
described in Appendix. The search was conducted by an experienced biomedical librarian and
included studies between 1990, seven years before Charles et al. (1997) defined SDM, and June
16, 2016. Our search strategy was conducted in five steps. First, we identified four theoretical
concepts or sets: SDM, mental health, patient involvement, and relationships. Second, we
identified Medical Subject Headings terms frequently constrained to major-headings, using the
asterisk, with selected content-relevant text-word phrases for each set (Appendix).
Third, we combined the different sets in three different configurations (see Figure 1). Fourth,
we combined the three intersections in each of the three combinations. Finally, we applied
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