This thesis investigated treatment decision-making (TDM) in psychosis, where people might experience distress and impairments to functioning associated with positive symptoms (hallucinations; delusions; disordered thinking or behaviour) and negative symptoms (flattened affect, avolition).Paper 1 reports a systematic review and exploratory meta-analysis of shared decision-making (SDM) interventions for psychosis. Eight randomised controlled trials were included that compared an intervention to enhance SDM around treatment or care for psychosis with a control intervention. Empowerment-related outcomes were examined and the quality of the evidence evaluated. Small, statistically significant positive effects of SDM were found on indices of subjective empowerment and aspects of patient-clinician relationships. No significant effects on indices of objective coercion or participants' decision-making abilities were found. The quality of the evidence was generally low. It was concluded that higher-quality studies are needed that include outcomes of importance to service users.Paper 2 reports a qualitative study that employed Interpretative Phenomenological Analysis (IPA) to explore the experiences of TDM of seven service users with psychosis. Of interest was how participants' experience might relate to ways of promoting service users' values and goals in TDM, with particular reference to issues of treatment decision-making capacity (TDMC), or abilities to make a particular decision about treatment. Four themes were identified, linked by an overarching theme of empowerment. They concerned not being listened to; influence of psychosis-related experience; being inadequately informed and supported; and influence of a Recovery orientation, wherein service users' values and goals are of primary concern. The importance of listening closely to service users with psychosis and of awareness of power dynamics in TDM was identified, along with the need to develop more comprehensive models of TDMC.Paper 3 reflects on the thesis context; the process of project planning and design; the quality of the work; the merits and limitations of the line of enquiry; clinical, theoretical and research implications; and the author's experience of completing the work in the context of her background and values. The paper seeks a cohesive overview of the thesis, the process of its production and its contribution to the literature.
|Date of Award||31 Dec 2014|
- The University of Manchester
|Supervisor||Anthony Morrison (Supervisor) & Alison Wearden (Supervisor)|