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 Walker; Peter Bower

doi:10.1371/journal.pone.0201533

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 journal › Article › peer-review

Abstract

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 language	English
Pages (from-to)	e0201533
Journal	PLoS ONE
Volume	13
Issue number	8
DOIs	https://doi.org/10.1371/journal.pone.0201533
Publication status	Published - 1 Aug 2018

Keywords

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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10.1371/journal.pone.0201533

Cite this

Lovell, K., Bee, P., Brooks, H., Cahoon, P., Callaghan, P., Carter, L.-A., Cree, L., Davies, L., Drake, R., Fraser, C., Gibbons, C., Grundy, A., Hinsliff-Smith, K., Meade, O., Roberts, C., Rogers, A., Rushton, K., Sanders, C., Shields, G., ... Bower, P. (2018). Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. PLoS ONE, 13(8), e0201533. https://doi.org/10.1371/journal.pone.0201533

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

abstract = "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.",

keywords = "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",

author = "Karina Lovell and Penny Bee and Helen Brooks and Patrick Cahoon and Patrick Callaghan and Lesley-Anne Carter and Lindsey Cree and Linda Davies and Richard Drake and Claire Fraser and Chris Gibbons and Andrew Grundy and Kathryn Hinsliff-Smith and Oonagh Meade and Chris Roberts and Anne Rogers and Kelly Rushton and Caroline Sanders and Gemma Shields and Lauren Walker and Peter Bower",

year = "2018",

month = aug,

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doi = "10.1371/journal.pone.0201533",

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Lovell, K, Bee, P, Brooks, H, Cahoon, P, Callaghan, P, Carter, L-A, Cree, L, Davies, L, Drake, R, Fraser, C, Gibbons, C, Grundy, A, Hinsliff-Smith, K, Meade, O, Roberts, C, Rogers, A, Rushton, K, Sanders, C, Shields, G, Walker, L & Bower, P 2018, 'Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial', PLoS ONE, vol. 13, no. 8, pp. e0201533. https://doi.org/10.1371/journal.pone.0201533

TY - JOUR

T1 - Embedding shared decision-making in the care of patients with severe and enduring mental health problems

T2 - The EQUIP pragmatic cluster randomised trial

AU - Lovell, Karina

AU - Bee, Penny

AU - Brooks, Helen

AU - Cahoon, Patrick

AU - Callaghan, Patrick

AU - Carter, Lesley-Anne

AU - Cree, Lindsey

AU - Davies, Linda

AU - Drake, Richard

AU - Fraser, Claire

AU - Gibbons, Chris

AU - Grundy, Andrew

AU - Hinsliff-Smith, Kathryn

AU - Meade, Oonagh

AU - Roberts, Chris

AU - Rogers, Anne

AU - Rushton, Kelly

AU - Sanders, Caroline

AU - Shields, Gemma

AU - Walker, Lauren

AU - Bower, Peter

PY - 2018/8/1

Y1 - 2018/8/1

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Decision Making

KW - England

KW - Feasibility Studies

KW - Female

KW - Health Care Surveys/statistics & numerical data

KW - Humans

KW - Male

KW - Mental Disorders/diagnosis

KW - Mental Health

KW - Middle Aged

KW - Patient Participation

KW - Patient Satisfaction

KW - Self Report

KW - Young Adult

U2 - 10.1371/journal.pone.0201533

DO - 10.1371/journal.pone.0201533

M3 - Article

C2 - 30133461

SN - 1932-6203

VL - 13

SP - e0201533

JO - PLoS ONE

JF - PLoS ONE

IS - 8

ER -

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

Abstract

Keywords

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