Francis Cathy J, Johnson Amanda, Wilson Rhonda L
University of Newcastle, Newcastle, New South Wales, Australia.
Head of School, Dean of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia.
Health Expect. 2024 Apr;27(2):e14001. doi: 10.1111/hex.14001.
There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice.
We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation.
Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews.
Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians).
On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer.
This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.
全球范围内，推动精神卫生服务使用者更多地参与其护理和治疗规划的机会的势头日益增强。精神卫生保健专业人员普遍在原则上支持这一目标。然而，在实践中，精神卫生服务在实现这一目标方面进展滞后。
我们对有关改善精神卫生保健服务使用者参与治疗规划机会的干预措施的定量、定性和混合方法研究进行了系统综述，以了解当前的研究证据和实施障碍。
检索了七个数据库，筛选了5137篇文章。纳入的文章需报告针对成年服务使用者的干预措施，发表于2008年至2023年10月之间且为英文。根据JBI关于混合方法系统综述的指南，对140篇纳入文章中的证据进行了综合。
该领域的研究本质上仍处于探索阶段，迄今为止研究了广泛的干预措施，但很少有实验性重复。精神卫生治疗规划中共同决策和支持性决策的总体障碍包括：（1）组织方面（资源限制、文化障碍、风险管理优先级和结构）；（2）过程方面（知识不足、时间限制、与健康相关的担忧、完成和使用计划的问题）；以及（3）关系障碍（服务使用者和临床医生双方的恐惧和不信任）。
基于所确定的障碍，提出了相关建议，以推动新政策和项目的实施、新工具的设计，并为寻求在其所提供的医疗保健中实践共同决策和支持性决策的临床医生提供指导。
这项系统综述在所有阶段都由一位有精神卫生服务使用经验的研究人员指导，该研究人员目前不希望被识别。研究结果可为组织、研究人员和从业者在实施支持性决策方面提供参考，以便让精神疾病患者更多地参与其医疗保健。
