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Clinical decision-making and outcome in routine care for people with severe mental illness (CEDAR)

CEDAR was a study of clinical decision-making which took place in Denmark, England (King’s College London), Germany, Hungary, Italy and Switzerland from 2009 until 2012. The study was funded by a grant from the European Union (reference 223290).

We developed and evaluated three measures, each in five languages (Danish, English, German, Hungarian and Italian). Measures are available via the CEDAR website. The CDMS measure assesses preference for decision-making style, the CDIS measure assesses experience of involvement and satisfaction with decisions, and the CDRC measure assesses the content and implementation of decisions.

We then evaluated the experience of clinical decison-making for 588 people using mental health services in the six countries, as described in the study protocol. We showed that more active involvement in decision-making by the mental health service user was associated with better outcomes, including increased satisfaction and fewer unmet needs, but active involvement was associated with lower stage of recovery one year later. Participants differed in their pattern of change in helping alliance and we found a causal relationship between improving helping alliance and reducing unmet needs. Most participants had a high desire for information. Treatment-related decisions were associated with lower satisfaction, involvement and implementation, and a preference for shared decision-making may reduce healthcare costs. Desire for involvement differed across countries, with shared decision-making less used with psychiatrists compared with other professional groups.