Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial.
BACKGROUND:Severe mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC6104914?pdf=render |
| _version_ | 1819229091545481216 |
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| author | Karina Lovell Penny Bee Helen Brooks Patrick Cahoon Patrick Callaghan Lesley-Anne Carter Lindsey Cree Linda Davies Richard Drake Claire Fraser Chris Gibbons Andrew Grundy Kathryn Hinsliff-Smith Oonagh Meade Chris Roberts Anne Rogers Kelly Rushton Caroline Sanders Gemma Shields Lauren Walker Peter Bower |
| author_facet | Karina Lovell Penny Bee Helen Brooks Patrick Cahoon Patrick Callaghan Lesley-Anne Carter Lindsey Cree Linda Davies Richard Drake Claire Fraser Chris Gibbons Andrew Grundy Kathryn Hinsliff-Smith Oonagh Meade Chris Roberts Anne Rogers Kelly Rushton Caroline Sanders Gemma Shields Lauren Walker Peter Bower |
| author_sort | Karina Lovell |
| collection | DOAJ |
| description | BACKGROUND:Severe mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning. METHODS:We cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of 'autonomy support'. Primary and secondary outcomes were collected by self-report, six months after allocation. FINDINGS:In total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome. CONCLUSIONS:An intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term. |
| first_indexed | 2024-12-23T11:07:40Z |
| format | Article |
| id | doaj.art-157fcecc61d7450a9e4e6a28050f3352 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-23T11:07:40Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-157fcecc61d7450a9e4e6a28050f33522022-12-21T17:49:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01138e020153310.1371/journal.pone.0201533Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial.Karina LovellPenny BeeHelen BrooksPatrick CahoonPatrick CallaghanLesley-Anne CarterLindsey CreeLinda DaviesRichard DrakeClaire FraserChris GibbonsAndrew GrundyKathryn Hinsliff-SmithOonagh MeadeChris RobertsAnne RogersKelly RushtonCaroline SandersGemma ShieldsLauren WalkerPeter BowerBACKGROUND:Severe mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning. METHODS:We cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of 'autonomy support'. Primary and secondary outcomes were collected by self-report, six months after allocation. FINDINGS:In total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome. CONCLUSIONS:An intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term.http://europepmc.org/articles/PMC6104914?pdf=render |
| spellingShingle | Karina Lovell Penny Bee Helen Brooks Patrick Cahoon Patrick Callaghan Lesley-Anne Carter Lindsey Cree Linda Davies Richard Drake Claire Fraser Chris Gibbons Andrew Grundy Kathryn Hinsliff-Smith Oonagh Meade Chris Roberts Anne Rogers Kelly Rushton Caroline Sanders Gemma Shields Lauren Walker Peter Bower Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. PLoS ONE |
| title | Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. |
| title_full | Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. |
| title_fullStr | Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. |
| title_full_unstemmed | Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. |
| title_short | Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. |
| title_sort | embedding shared decision making in the care of patients with severe and enduring mental health problems the equip pragmatic cluster randomised trial |
| url | http://europepmc.org/articles/PMC6104914?pdf=render |
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