From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living With Psychosis (SHAPE): A Realist Review (Part 2-Designing SDM Interventions: Optimizing Design and Local Implementation).
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Authors
Fitzgerald, Ita
Howe, Jo
Maidment, Ian
Wallace, Emma
Zisman-Ilani, Yaara
Højlund, Mikkel
O'Dwyer, Sarah
Ní Dhubhlaing, Ciara
Crowley, Erin K
Sahm, Laura J
Issue Date
2025-05-21
Type
Journal Article
Language
en
Keywords
antipsychotics , decision aid , realist review , shared decision making
Alternative Title
Abstract
Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 2 of this 2-part realist review aimed to understand what SDM intervention strategies and local implementation contexts are responsible for successful prescriber engagement and why.
CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science, and Google Scholar were searched for evidence to develop realist program theories explaining relationships between meso- and micro-level contexts and impact on prescriber behaviors.
From 106 included documents, 5 program theories were developed explaining mechanisms responsible for increasing prescriber engagement with desired behaviors, alongside facilitative features within service delivery contexts and workforce development. Key mechanisms included reducing prescriber fear of sole responsibility for harm, reducing the perceived burden of SDM, increasing prescriber confidence in their ability to productively negotiate treatment consultations and their confidence to safely increase patient autonomy within decision-making. These mechanisms should be the focus of those interested in designing SDM interventions to increase prescriber engagement and those responsible for translating results of effective interventions into real-world settings to ensure facilitative contexts are maintained.
Intervention strategies that should be prioritized for scale-up include attempting SDM within existing therapeutic relationships, adopting a multidisciplinary team (MDT) responsibility for SDM implementation, and workforce training in skillsets required of effective SDM application. Efforts to standardize psychosis care via MDTs and systematically reduce discontinuity and fragmentation of care are required at policy-level.
CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science, and Google Scholar were searched for evidence to develop realist program theories explaining relationships between meso- and micro-level contexts and impact on prescriber behaviors.
From 106 included documents, 5 program theories were developed explaining mechanisms responsible for increasing prescriber engagement with desired behaviors, alongside facilitative features within service delivery contexts and workforce development. Key mechanisms included reducing prescriber fear of sole responsibility for harm, reducing the perceived burden of SDM, increasing prescriber confidence in their ability to productively negotiate treatment consultations and their confidence to safely increase patient autonomy within decision-making. These mechanisms should be the focus of those interested in designing SDM interventions to increase prescriber engagement and those responsible for translating results of effective interventions into real-world settings to ensure facilitative contexts are maintained.
Intervention strategies that should be prioritized for scale-up include attempting SDM within existing therapeutic relationships, adopting a multidisciplinary team (MDT) responsibility for SDM implementation, and workforce training in skillsets required of effective SDM application. Efforts to standardize psychosis care via MDTs and systematically reduce discontinuity and fragmentation of care are required at policy-level.
Description
Citation
Fitzgerald I, Howe J, Maidment I, Wallace E, Zisman-Ilani Y, Højlund M, O'Dwyer S, Ní Dhubhlaing C, Crowley EK, Sahm LJ. From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living With Psychosis (SHAPE): A Realist Review (Part 2-Designing SDM Interventions: Optimizing Design and Local Implementation). Schizophr Bull. 2025 May 21:sbaf059. doi: 10.1093/schbul/sbaf059. Epub ahead of print. PMID: 40396338.
Publisher
License
© The Author(s) 2025. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Journal
Schizophrenia bulletin
Volume
Issue
PubMed ID
ISSN
1745-1701