Shared Decision Making im allgemeinpsychiatrischen Akutsetting: Eine cluster-randomisierte Studie in der Behandlung der Schizophrenie (SDMPLUS)

Aims Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM PLUS). Methods The study is a multi-center, cluster-randomized, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of 5 psychiatric hospitals addressing inpatients suffering from schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS-approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under treatment as usual conditions. The primary outcome parameter was the patients' perceived involvement in decision making at 3 weeks after study enrolment, analyzed using a random effects linear regression model. Retrospectively obtained data on incidents of patient aggression and coercive measures were additionally analyzed post-hoc. Results 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision making measured by the SDM-Q-9 questionnaire. In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalization rates in the 12-month follow-up. The intervention showed no effect on patient aggression and coercive measures. Still patients admitted involuntarily or featuring incidents of aggression profited similarly from the intervention with regard to perceived involvement, adherence, and treatment satisfaction as patients admitted voluntarily or featuring no incidents of aggression. Conclusions Despite limitations in patient recruitment the SDM-Plus trial has shown that the adoption of behavioral approaches (e. g., motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment.