Shared decision-making preferences in mental health: does age matter? A systematic review

Research to date suggests older adults prefer a passive involvement in the clinical decision-making process; however, the empirical evidence underlying this claim in the mental health context is yet to be reviewed systematically. To understand whether older adults desire involvement in mental health-related clinical decisions. A systematic review was conducted to identify primary research that explored mental-health decision-making preferences of people with a mean age of over 55 from January 1990 through to December 2018. Three independent studies of varying design and quality were included. Study settings were in the USA, Germany, and the UK. A preference for shared decision-making was seen in two studies, while a preference for active decision-making was identified in one. In contrast to other reviews on clinical decision-making, this review focused on mental health-related decisions of older adults. The evidence suggests older adults desire involvement in mental health-related clinical decisions. Given the political drive to empower patients and the need to ensure evidence-based clinical practice, more high-quality research regarding the shared decision-making preferences and outcomes of older adults with mental ill-health is needed. <b>Systematic Review Registration PROSPERO:</b> CRD42018102009

迄今为止的相关研究表明，老年群体更倾向于以被动方式参与临床决策流程；然而，精神健康场景下支撑该结论的实证证据，仍有待开展系统性梳理与综述。为明确老年群体是否希望参与精神健康相关的临床决策，本研究于1990年1月至2018年12月期间开展系统综述（systematic review），旨在检索探索平均年龄55岁以上人群精神健康决策偏好的原始研究。最终纳入3项设计与质量水平各异的独立研究，研究开展地分别为美国、德国与英国。两项研究显示受试者偏好共同决策（shared decision-making），另有一项研究则发现受试者倾向于主动决策（active decision-making）。与其他临床决策相关综述不同，本综述聚焦老年群体的精神健康相关临床决策。现有证据表明，老年群体希望参与精神健康相关的临床决策。鉴于推动患者赋权的政策导向，以及确保临床实践循证化的需求，未来仍需开展更多高质量研究，以探索精神疾病老年群体的共同决策偏好与相关结局。系统综述注册信息：PROSPERO CRD42018102009