Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial

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 WalkerPeter Bower

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)e0201533
JournalPLoS ONE
Issue number8
Publication statusPublished - 1 Aug 2018


  • Adult
  • Aged
  • Decision Making
  • England
  • Feasibility Studies
  • Female
  • Health Care Surveys/statistics & numerical data
  • Humans
  • Male
  • Mental Disorders/diagnosis
  • Mental Health
  • Middle Aged
  • Patient Participation
  • Patient Satisfaction
  • Self Report
  • Young Adult


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