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Training patients with schizophrenia to share decisions with their psychiatrists: a randomized-controlled trial

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients’ communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence.

Methods

Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient–doctor interaction such as question asking or giving feedback.

Results

N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients’ participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists’ estimate) their behavior in psychiatric consultations.

Conclusions

While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients’ active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.

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Acknowledgements

The authors would like to thank all team members of the participating hospitals (Isar Amper Klinikum München Ost, BKH Mainkofen, BKH Kaufbeuren) for their support.

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Authors and Affiliations

  1. Psychiatric Department, Technische Universität München, Munich, Germany

    Johannes Hamann, Anna Parchmann, Nina Sassenberg, Katharina Bronner & Werner Kissling

  2. Isar Amper Klinikum München Ost, Haar, Germany

    Margot Albus

  3. Bezirkskrankenhaus Mainkofen, Deggendorf, Germany

    Alwin Richter

  4. Bezirkskrankenhaus Kaufbeuren, Kaufbeuren, Germany

    Sandra Hoppstock

Authors
  1. Johannes Hamann
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  2. Anna Parchmann
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  3. Nina Sassenberg
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  4. Katharina Bronner
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  5. Margot Albus
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  6. Alwin Richter
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  7. Sandra Hoppstock
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  8. Werner Kissling
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Corresponding author

Correspondence to Johannes Hamann.

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Funding

The study was funded by the German Ministry for Research and Education, BMBF, Bonn, Germany, Grant No. 01GX1032.

Conflict of interest

JH. and W.K. received lecture honoraria from JnJ, Lilly and Otsuka and research grants from JnJ and Lilly.

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Hamann, J., Parchmann, A., Sassenberg, N. et al. Training patients with schizophrenia to share decisions with their psychiatrists: a randomized-controlled trial. Soc Psychiatry Psychiatr Epidemiol 52, 175–182 (2017). https://doi.org/10.1007/s00127-016-1327-z

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  • DOI: https://doi.org/10.1007/s00127-016-1327-z

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