Table 1 Main features of the included studies

Hamann et al. (Germany), [38]

Pilot study with random allocation

N = 61 patients (shared decision making training, N = 32; control condition, N = 29); acute psychiatric ward

Schizophrenia, schizoaffective disorder

Patients’ age 18–60 years

Shared decision-making training: five 1-h group sessions, including the importance of shared decision-making process, motivational aspects and the use of role-plays

Control condition: five-sessions of cognitive training group

Patients receiving the shared decision-making training reported higher participation preferences and increased patients’ desire to have more responsibility in treatment decisions, which continued at 6-month follow-up

An et al. (Korea), [39]

Quasi-experimental, non-equivalent pre/post-test design

N = 60 (Experimental group, N = 29; Control group, N = 31); acute psychiatric ward

Schizophrenia or schizoaffective disorder based on DSM-IV-TR criteria

Patients’ age 19 years old or older

SMD training program: consists of 8-weekly group sessions based on the SDM guidelines. The topics include: general information on the program; education on the significance of SDM; communication; expression of patient’s needs and preferences for treatment; understanding the needs of others; coordinating opinions in decision-making situations; demonstrating the SDM in various scenarios; practicing the SDM in real situation

Control group: treatment as usual

Patients receiving the SDM training program report an improvement in the levels of self-esteem, problem-solving ability, and quality of life compared to patients allocated in the control group

McCabe et al. (UK), [40]

Cluster randomised control trial

N = 72 patients (Experimental group, N = 36; Control group, N = 36), N = 12 psychiatrists; psychiatric out-patient clinics or community mental health services

Schizophrenia or schizoaffective disorder according to ICD-10 criteria

Patients’ age: 18–65 years

TEMPO training: focused to mental health professionals, including the following topics: understanding the patient with psychotic experiences: reflecting on the patient’s experience and the professional and emotional response to psychotic symptoms; communication techniques for working with positive and negative symptoms; empowerment of the patient; involvement in decision-making about medication

Control group: treatment as usual

Patients treated by psychiatrists receiving the TEMPO training reported a more positive therapeutic relationship as did psychiatrists

Ramon et al. (United Kingdom), [41]

Naturalistic study, before and after, uncontrolled design

N = 47 service users, N = 35 care-coordinators and N = 12 psychiatrists; community services

for adults with long-term mental health problems

Schizophrenia, bipolar disorder and depression

Patients’ age: 18–65 years; in charge at rehabilitation and recovery services for at least 6 months; taking any psychiatric medication for at least 6 months

Training was delivered to separate groups of service users, psychiatrists and care coordinators. The core content was the same for all groups and focused on the process of SDM. Training sessions were delivered at fortnightly or monthly intervals. Training was offered to all psychiatrists and care coordinators who prescribe, monitor or discuss medication with service users

Patients reported a change in decisional conflict and perceptions of practitioners’ interactional style in promoting SDM at the follow-up. A positive impact was found on service users’ and care coordinators confidence to explore medication experience, and group-based training was valued

Ishii et al. (Japan), [42]

Randomized, parallel-group, two-arm, open-label, single-center study

N = 24 patients (shared decision making group, N = 11; Usual care group, N = 13); acute psychiatric ward

Schizophrenia spectrum disorder according to ICD-10 criteria

Patients’ age 16–65 years; no previous psychiatric admission

Shared Decision Making group (SDM): 15–20-min weekly intervention provided during the in-patient stay, consisting of three elements: evaluation of patient’s perceptions of on-going treatments; sharing patients’ and medical staffs’ perceptions on the treatments; shared definition of care plan

Usual care group: usual psychiatric inpatient care, which mainly include pharmacological treatments

Patients in the SDM group reported a higher level of satisfaction towards treatments compared to usual care group, while no differences were found in attitude toward medication, treatment continuation and in the levels of global functioning

Hamann et al. (Germany), [43]

Randomized-controlled trial, multicenter study

N = 264 (intervention group, N = 142; control group, N = 122); acute wards of four participating

psychiatric hospitals

Schizophrenia, schizoaffective disorder according to ICD-10 criteria

Patients’ age 18–60 years

Shared Decision Making (SDM): 5-session training (60 min/session) addressing patient competencies for SDM, including sessions on motivational and behavioral aspects (e.g., role plays) and on patient–doctor interaction

Control group: 5-session of cognitive training, but with no reference to doctor-patient communication

Patients in the SDM group reported an increase in their levels of participation preferences and their wish to take over more responsibility for medical decision. No differences regarding the treatment adherence were found at 6 and 12 months after discharge

Finnerty et al. (USA), [44]

Multicentre study

N = 1416 patients (MyCHOIS–CommonGround, N = 472; control condition, N = 944); 12 Medicaid outpatient clinics

Anxiety disorder, bipolar/depressive disorder, post-traumatic stress disorder, schizophrenia spectrum disorder, sleep–wake disorder, substance-related or addictive disorder

Adult patients served by MyCHOIS–CommonGround clinics between 2011–2014

MyCHOIS–CommonGround: Web-based shared decision-making application on outpatient mental health treatment engagement and on antipsychotic medication adherence

Control group: simple random sample of adult Medicaid receiving a mental health clinic service

At one-year follow-up, patients in the MyCHOIS–CommonGround report higher level of engagement in outpatient mental health services and of adherence to antipsychotic medication compared to the control group

Kane et al. (USA), [35]

Randomized controlled trial

N = 255 patients; community “real world” mental health clinics

Schizophrenia diagnosis confirmed by SCID-5

Patients’ age: 18-35 years; less than 5 years of antipsychotic lifetime use

Experimental group: to provide LAI treatment with long-acting aripiprazole monohydrate (Aripiprazole Once Monthly). Clinicians received a training course on the role of non-adherence in relapse and hospitalization, effectiveness of LAI antipsychotic, shared decision-making principles, communication strategies

Treatment as usual group: defined as the Clinician’s Choice condition

91% of patients accepted at least one LAI antipsychotic during the first 3 months participation to the trial