Results Summary

What was the research about?

Shared decision making is a process in which patients work with their doctors to select tests and treatments based on what is most important to them. Shared decision making is uncommon in community mental health clinics.

In this study, the research team created a program to support shared decision making for patients with mental illness. The team wanted to learn if patients with mental illness who received treatment from community clinics that used the program

  • Understood their treatment options
  • Became more involved with treatment decision making
  • Felt more satisfied with treatment decisions and with communication with their doctor
  • Had improved progress in response to treatment, quality of life, and mental and physical health
  • Felt more support during therapy

What were the results?

The study found no differences between patients in clinics that used the program and those in clinics that did not use the program in

  • Satisfaction with treatment decisions
  • Communication with doctors
  • Involvement in decision making
  • Treatment progress
  • Quality of life

However, of patients who completed interviews after the study, 94 percent said they had some benefit from taking part in the program. These benefits included improved self-esteem and feeling more involved in their care.

Who was in the study?

The study included 240 patients from four community mental health clinics. Two of the clinics were in a city in California, and two were in rural New Mexico. Of the patients, 53 percent were female, 55 percent were white, and 26 percent were Hispanic. The average patient age was 58.

What did the research team do?

The team assigned the program to one of the urban clinics and one of the rural clinics by chance. Sixty patients at each clinic took part in the study.

All patients in the study received their usual mental health care. The patients took a survey at the start of the study and again every six months for two years. The survey asked about patients’ satisfaction with treatment decisions, communication with doctors, involvement in decision making, treatment progress, and quality of life. The research team also interviewed patients in the program at the end of the study or if they left the study early.

What were the limits of the study?

The mental health clinics that used the shared decision making program had challenges that affected the study. Staff did not always carry out the program, and many staff members left their jobs during the study. Patients at the clinics that did and didn’t use the program differed in age, race, ethnicity, and other social factors. The results may have been different if more and better matched clinics took part in the study.

Future research could compare the shared decision making program to regular care in larger studies with better matched clinics.

How can people use the results?

Patients said the program improved their self-esteem and made them feel more involved in their care. Community health clinics may be interested in further exploring shared decision making with their patients.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.

In response to peer review, the PI made changes including

  • Describing how the decision aids evaluated in this study aligned with accepted standards established in the International Patient Decision Aids Standards. Reviewers noted that some components of the mPOWR intervention that focused on quality of life rather than medical decision making, but the researchers did indicate which standards were applicable to which parts of the decision aid.
  • Specifying which of the many outcome measures were the primary outcomes on which the conclusions were based. The reviewers had found it difficult to determine which outcomes were most important in this research, and which should be considered more exploratory.
  • Elaborating on the content of the shared decision making system and decision aids by including copies of the protocol and tools in an appendix. The draft report lacked specific information about these tools, making it difficult to evaluate the scientific quality of the intervention results.
  • Expanding on study limitations to consider whether the intervention itself caused some barriers to uptake by clients. This was based on reviewer recommendations responding to the high rates of both incomplete implementation of the intervention, and high patient drop-out from the intervention.

Finally, while reviewers argued that the researchers could have used a simpler statistical approach given the small sample size and high dropout rate, they appreciated the clear presentation of study results, which showed that the decision aid did not improve primary or secondary outcomes relative to usual care.

Conflict of Interest Disclosures

Project Information

Joyce Chu, PhD^
Family Service Agency of San Francisco
Researching the Effectiveness of a Decision-Support Tool for Adult Consumers with Mental Health Needs and their Care Managers

Key Dates

May 2013
March 2018

Study Registration Information

^Shobha Pais, MS, PhD, and Erika Van Buren, PhD, were the original principal investigators for this project.


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Last updated: January 25, 2023