AUTHOR=Vitger Tobias , Korsbek Lisa , Austin Stephen F. , Petersen Lone , Nordentoft Merete , Hjorthøj Carsten 

TITLE=Digital Shared Decision-Making Interventions in Mental Healthcare: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.691251

DOI=10.3389/fpsyt.2021.691251

ISSN=1664-0640

ABSTRACT=Shared decision-making in mental healthcare has received increased attention as a process to reinforce person-centered care. With the rapid development of digital health technology, researchers investigate how digital interventions may be utilized to support shared decision-making. Despite the promise of digital interventions to support shared decision-making, the effect of these in mental healthcare has not been evaluated before. Thus, this paper aims to assess the effect of shared decision-making interventions complimented by digital technology in mental healthcare.

Methods
A systematic review and meta-analysis of randomized controlled trials on digital shared decision-making interventions for people with a mental health condition. We searched for relevant studies in MEDLINE, PsycINFO, EMBASE, CINAHL and The Cochrane Central Register of Controlled Trials. The primary outcome was patient activation or indices of the same, adherence to treatment, hospital admissions, severity of symptoms and level of functioning. Secondary outcomes were satisfaction, decisional conflict, working alliance, usage and adherence of medicine and adverse events defined as harms or side effects.

Results
16 studies met the inclusion criteria with outcome data from 2400 participants. Digital shared decision-making interventions had a moderate positive effect compared to a control condition on patient activation (SMD = 0.56, CI: 0.10, 1.01, p=0.02), a small effect on general symptoms (SMD = -0.17, CI: -0.31, -0.03, p=0.02), working alliance (SMD = 0.21, CI: 0.02, 0.41, p=0.03) and for improving decisional conflict (SMD = -0.37, CI: -0.70, -0.05, p = 0.02). No effect was found on self-efficacy, other types of mental health symptoms, adverse events or patient satisfaction. A total of 39 outcomes were narratively synthesized with results either favoring the intervention group or showing no significant differences between groups. Studies were generally assessed to have unclear or high risk of bias, and outcomes had a GRADE rating of low- or very low-quality evidence. 

Conclusions
Digital interventions to support SDM may be a promising tool in mental healthcare but with the limited quality of research, we have little confidence in the estimates of effect. More quality research is needed to further assess the effectiveness of digital means to support SDM.