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Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing

  • Rebecca Pedley (a1), Caitlin McWilliams (a2), Karina Lovell (a2), Helen Brooks (a3), Kelly Rushton (a2), Richard J. Drake (a4), Barnaby Rumbold (a5), Vicky Bell (a2) and Penny Bee (a6)...



Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication.


To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions.


Systematic thematic synthesis.


Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes.


Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement.

Declaration of interest


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This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Rebecca Pedley, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Room 6.306 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL. Email:


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Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing

  • Rebecca Pedley (a1), Caitlin McWilliams (a2), Karina Lovell (a2), Helen Brooks (a3), Kelly Rushton (a2), Richard J. Drake (a4), Barnaby Rumbold (a5), Vicky Bell (a2) and Penny Bee (a6)...
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