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In the UK almost 60% of people with a diagnosis of schizophrenia who use
mental health services say they are not involved in decisions about their
treatment. Guidelines and policy documents recommend that shared
decision-making should be implemented, yet whether it leads to greater
treatment-related empowerment for this group has not been systematically
To examine the effects of shared decision-making on indices of
treatment-related empowerment of people with psychosis.
We conducted a systematic review and meta-analysis of randomised
controlled trials (RCTs) of shared decision-making concerning current or
future treatment for psychosis (PROSPERO registration CRD42013006161).
Primary outcomes were indices of treatment-related empowerment and
objective coercion (compulsory treatment). Secondary outcomes were
treatment decision-making ability and the quality of the therapeutic
We identified 11 RCTs. Small beneficial effects of increased shared
decision-making were found on indices of treatment-related empowerment (6
RCTs; g = 0.30, 95% CI 0.09–0.51), although the effect
was smaller if trials with >25% missing data were excluded. There was
a trend towards shared decision-making for future care leading to reduced
use of compulsory treatment over 15–18 months (3 RCTs; RR = 0.59, 95% CI
0.35–1.02), with a number needed to treat of approximately 10 (95% CI
5–∞). No clear effect on treatment decision-making ability (3 RCTs) or
the quality of the therapeutic relationship (8 RCTs) was found, but data
For people with psychosis the implementation of shared treatment
decision-making appears to have small beneficial effects on indices of
treatment-related empowerment, but more direct evidence is required.
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