Friday, January 29, 2016

Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature

Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients’ preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD.

An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool.

N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques.

Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients’ preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders.

Treatment preferences of participants.
Research objectiveTreatment preferences
Preference for a settingProfessional outpatient was preferred to inpatient[37]
Residential treatment was preferred to outpatient[39]
Outpatient treatment was preferred to residential[38,40,50,51]
Full day treatment was preferred to outpatient[48]
Strong preference for either in- and outpatient treatment[46]
Preference for a serviceMotivational Enhancement Therapy was preferred to Non-directive reflective listening[42]
Alternative Treatment was preferred to Alcohol Anonymous (AA)[41]
Self-help groups was preferred to online sessions or self-help booklets[37]
Individual therapy was preferred to couple therapy[49]
Detoxification was preferred to Narcotic Anonymous (NA)[39]
AA was preferred to detoxification[38]
Individual counseling was preferred to AA/NA and group counseling[39,40]
Getting help from doctor was preferred to AA[34]
Individual counseling was preferred to intensive counseling[52]
An optional smoking cessation program was preferred to no program[43]
Medical, mental health, family, vocational and housing services were preferred to e.g. communication or anger management services[45,47]
Preference for a goalReduction was preferred to no change or abstinence[41]
Abstinence was preferred to moderate drinking[35,38]
Preference for a therapistThere was no preference for either gender[37]
There was no preference for sexual orientation of therapist[37]
Preference for a medicationMethadone was preferred to Buprenorphine[36,39]
Buprenorphine was preferred to Methadone[36]
[34]Lieberman et al. (2014), [35]Flach & Diener (2004), [36]White et al. (2007), [37]Green (2011), [38]Goebert & Nishimura (2011), [39]Luty (2004), [40]Tuten et al. (2007), [41]Dillworth et al. (2009), [42]Adamson et al. (2006), [43]Bernstein et al. (1999), [45]Friedman et al. (1999), [46]Gossop et al. (1986), [47]Hser et al. (1999), [48]Marlowe et al. (2003), [49]McCrady et al. (2011),[50]McKay et al. (1995), [51]McKay et al. (1998), [52]Sterling et al. (1997).

Full article at:

Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Medical University of Vienna

No comments:

Post a Comment