(PS5-C70) The Role of Shared-decision Making in Promoting Family Participation in First-episode Psychosis Treatment

Engagement and involvement in first-episode psychosis (FEP) services are critical for adolescents and young adults to improve symptom trajectories and increase functioning. However, individuals with FEP disengage from services at high rates, especially if they enter an FEP program without a family member (Doyle et al., 2014). Identifying strategies to facilitate family engagement in FEP treatment is essential. One approach that could enhance family member involvement due to its supportive clinical culture is the shared decision-making (SDM) model, where clinicians, patients, and families work together to make decisions based on clinical knowledge and participant preferences and values (Elwyn et al., 2010). The SDM model has been shown to promote positive outcomes on the patient level, but research on the relationship between SDM and family engagement is limited. This study analyzed the role of SDM in promoting family participation in the treatment of youth and young adults with FEP.
Between December 2020 and June 2021, we administered a survey to 144 family members of adolescents and young adults served by OnTrackNY (OTNY), NY state’s treatment program for FEP. The survey captured perceptions of OTNY, including views about SDM. Based upon responses to one item regarding the family member’s perceived level of participation in OTNY, the sample was dichotomized into two groups; low (n=56, scored 1-3) and high participators (n=87, scored 4-5). Our dependent variable was the total SDM score, calculated by summing the ratings across five items inquiring about the use of specific SDM components. Because family participation varies by relative’s preference for involvement, we dichotomized participant ratings on an item asking about the level of loved ones’ encouragement to participate in their care; ratings of 1-3 generally indicated not encouraging, and 4-5 generally indicated encouraging.
Results found a statistically significant relationship between family participation by their loved one’s encouragement of their participation, X²₍₁₎=7.01, p=0.008. We used the level of loved one’s encouragement as a covariate in an analysis of covariance to evaluate the role of SDM in promoting family participation. Results indicated total SDM score was significantly higher in the high participators group (M=13.88, SD=1.68) than in low participators (M=11.62, SD=3.27), F(1, 120)=21.31, p< 0.001, partial η² = 0.15. Differences among high and low family participation groups on the SDM item level revealed similar trends.
Consistent with prior literature, these findings suggest that SDM is an important component of family-based-models participation (Thomas et al., 2020). The sample is likely biased toward a participatory sample due to the low response rate. The SDM model can be applied to CBT treatments for psychosis, which continues to be studied to facilitate change for individuals experiencing psychosis (Wood et al., 2013).