Shared decision making PLUS - a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS)

Area of Science:

• Psychiatry
• Health Services Research
• Clinical Psychology

Background:

• Shared decision-making (SDM) enhances patient involvement but faces implementation challenges in acute mental health settings.
• Traditional power imbalances between clinicians and patients hinder effective SDM.
• SDM-PLUS is designed to overcome these barriers for acutely ill psychiatric patients.

Purpose of the Study:

• To evaluate the effectiveness of the SDM-PLUS intervention in acute psychiatric inpatient settings.
• To improve patients' perceived involvement in decision-making during their hospital stay.
• To assess the impact of SDM-PLUS on therapeutic relationships and long-term outcomes like medication adherence.

Main Methods:

• A matched-pair cluster-randomized trial involving 276 patients with schizophrenia or schizoaffective disorder across 12 acute psychiatric wards.
• Intervention group wards received staff communication training and patient group interventions for SDM.
• Control group wards continued with treatment as usual; primary outcome measured by SDM-Q-9 questionnaire.

Main Results:

• The primary analysis will compare SDM-Q-9 scores between intervention and control groups using random effects linear regression.
• Secondary analyses will examine effects on therapeutic relationship, medication adherence, and rehospitalization rates.
• Process measures and qualitative data will identify barriers and facilitators to SDM-PLUS implementation.

Conclusions:

• This trial is the first to examine the SDM-PLUS approach in acute psychiatric inpatient settings for patients with schizophrenia or schizoaffective disorder.
• The complex intervention targets both patients and healthcare staff to maximize the impact on shared decision-making.
• Findings will inform the broader implementation of SDM in acute mental healthcare.