Objective

To compare the effectiveness of a community mental health-based shared decision making program called Moving Patient Outcomes toward Wellness and Recovery (mPOWR) to standard community-based mental health care.

Study Design

Design Elements	Description
Design	Quasi-experimental
Population	240 adults with mental illness
Interventions/ Comparators	Shared decision making support and training in addition to standard community-based mental health care Standard community-based mental health care (usual care)
Outcomes	Primary: decision satisfaction, communication satisfaction, patient involvement in shared decision making, perceived therapeutic support Secondary: treatment progress, general quality of life, mental and physical health
Timeframe	24-month follow-up for primary outcomes

The research team conducted a quasi-experimental evaluation of a shared decision making program, called mPOWR, for patients with mental illness being treated in community clinics. In shared decision making, patients are active partners in deciding their treatment with their clinicians. mPOWR is a package of shared decision making approaches, decision aids, and implementation guidance for clinicians that aims to help patients communicate their preferences and values, identify available service options, and participate in informed decision making about their care. The study’s primary outcomes were decision satisfaction, communication satisfaction, patient involvement in shared decision making, and perceived therapeutic support. Secondary outcomes were treatment progress, general quality of life, and mental and physical health.

The research team compared one urban and one rural community mental health clinic with a similar urban and rural community mental health clinic that did not employ the intervention. Researchers recruited patients from two clinics in urban California and two in rural New Mexico. In this study, 53% of patients were female, 55% were white, and 26% were Hispanic. The average patient age was 58.

At the start of the study, the research team randomly assigned one urban clinic and one rural clinic to the intervention. From a pool of eligible patients, the team randomly selected 60 patients at each clinic to participate.

The research team administered questionnaires at the beginning of the study and every six months for two years. Patients at all clinics received their standard mental health care during the study. Those at the two intervention sites also received the mPOWR program. The team conducted exit interviews with 77 patients in the intervention groups.

Results

Patients at the intervention clinics did not show greater improvement in the study outcomes than those at the control clinics. However, 94% of patients who completed the qualitative exit interviews said they received some benefit from participating in mPOWR, including improved self-esteem and feeling more involved or connected.

Limitations

The study encountered several challenges, including difficulties with buy-in among staff and high staff turnover at the intervention clinics. Patients at control and intervention clinics differed substantially in age, race, ethnicity, and other social factors, which made it difficult to distinguish treatment effects from the effects of confounding factors.

Conclusions and Relevance

The mPOWR intervention did not lead to greater improvements in primary study outcomes compared with standard community-based mental health care. However, exit interview results suggest that patients at community mental health clinics may benefit from participating in shared decision making interventions like mPOWR.

Future Research Needs

Future research could investigate ways to successfully integrate shared decision making interventions like mPOWR into treatment practices at community mental health clinics and test their effectiveness.