Effectiveness of Shared Decision-Making Compared With Usual Treatment in Patients With Severe Mental Disorder: Systematic Review of Randomized Clinical Trials

Introduction: The study seeks to describe the effectiveness, in terms of clinical, relational, epidemiological, or economic outcomes, of shared decision-making for the implementation of treatment compared to usual management in patients with severe mental disorders. Method: Systematic review of randomized clinical trials published in any language in PubMed, ClinicalTrials.gov, ICTRP, ProQuest, Embase, PsycInfo, and LILACS. Studies with hypothetical decisions, which only addressed the performance of decision-making tools, scale evaluation or research participation, were excluded. Results: Eight studies (5 countries) were included, with 596 patients in the shared decision-making group and 586 in control groups. All 8 studies included patients with schizophrenia and related disorders, one included patients with bipolar disorder, another included patients with major depressive disorder. The intervention consisted of communication and negotiation techniques (5 studies), decision support material (4 studies), explicit treatment goals (3 studies), family participation preferences (one study) and problem solving (one study). Shared decision-making showed improvement in social functioning, perceived participation, knowledge, satisfaction, and participation of family members. Conclusions: The inclusion criteria, intervention, comparator and outcomes were heterogeneous; the studies showed risk of bias. The model must be adequately defined, seeking relevant clinical and economic outcomes, and studied in the different diagnoses of severe mental disorder. There are limitations of the evidence due to heterogeneity, small sample size, and lack of measurement in the medium- and long-term outcomes.