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.
Systematic Review Registration PROSPERO: CRD42018102009

迄今为止的研究表明，老年群体更倾向于被动参与临床决策流程；然而，支撑该结论的实证依据在精神卫生领域仍有待开展系统性综述梳理。
本研究旨在明确老年群体是否希望参与精神卫生相关的临床决策。
本研究开展了一项系统性综述，检索了1990年1月至2018年12月期间，针对平均年龄55岁以上人群的精神卫生决策偏好的原创研究。
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。其中两项研究显示老年群体偏好共同决策模式，另有一项研究则发现其倾向于主动决策模式。
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卫生相关临床决策。现有证据表明，老年群体确实希望参与精神卫生相关的临床决策。鉴于当前推动患者赋权的政策导向，以及保障循证临床实践的现实需求，未来仍需开展更多高质量研究，聚焦精神疾病老年群体的共同决策偏好与结局情况。
系统性综述注册信息：PROSPERO，注册号CRD42018102009