Background
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.
Methods
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.
Results
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.
Discussion
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.
Research objective | Treatment preferences |
---|---|
Preference for a setting | Professional 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 service | Motivational 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 goal | Reduction was preferred to no change or abstinence[41] |
Abstinence was preferred to moderate drinking[35,38] | |
Preference for a therapist | There was no preference for either gender[37] |
There was no preference for sexual orientation of therapist[37] | |
Preference for a medication | Methadone 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: http://goo.gl/qu3mtq
By: Anke Friedrichs,* Maren Spies, Martin Härter, and Angela Buchholz
Department of
Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
Medical
University of Vienna
More at: https://twitter.com/hiv insight
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