The effectiveness and design of informed choice tools for people with severe mental illness: a systematic review

Abstract

Background

People with severe mental illness (SMI) report difficulty in making health-related decisions. Informed choice tools are designed to guide individuals through a decision-making process.

Aims

To determine the effectiveness of these tools for people with SMI and to identify what methods and processes may contribute to effectiveness.

Method

A systematic electronic search was conducted for studies published between 1996 and January 2018. The search was updated in March 2020. Studies of any design reporting the development or evaluation of any informed choice tool for people with SMI were considered. A structured, narrative synthesis was conducted.

Results

Ten articles describing four tools were identified. Tools were designed to assist with decision-making around bipolar treatment, smoking cessation and disclosure of mental illness in employment situations. Positive changes in decisional conflict, stage of change, knowledge and self-efficacy were reported for two tools, though insufficient data exists for definitive conclusions of effectiveness. Feedback from service users and attention to readability appeared key.

Conclusions

The evidence base for informed choice tools for people with SMI is limited. Such tools should be developed in stages and include the views of people with SMI at each phase; readability should be considered, and a theoretical framework should be used to facilitate process evaluation.

Keywords:

• Severe mental illness
• schizophrenia
• bipolar
• disorder
• intervention design
• informed choice tool
• decision-making

Acknowledgements

The authors are thankful to Dr Paul Walters, Consultant Psychiatrist and Research and Development Lead at Dorset HealthCare University NHS Foundation Trust, for his guidance on the Protocol. The authors are also grateful for the feedback received from Dr Elaine Brohan on a final version of the manuscript.

Protocol

The review protocol (Lamontagne-Godwin et al., 2017) is registered on the International prospective register of systematic reviews (PROSPERO Registration number: CRD42017083507).

Disclosure statement

One of the author (CH) was involved in the development of CORAL and led the RCT on it.

Additional information

Funding

This work was supported by a University of West London Vice-Chancellor PhD Scholarship in Allied Health (2017–2020). The funder had no involvement in the conduct of the research and/or preparation of the article.