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Impact of clinical decision-making participation and satisfaction on outcomes in mental health practice: results from the CEDAR European longitudinal study

Luciano, Mario; Fiorillo, Andrea; Brandi, Carlotta; Di Vincenzo, Matteo; Egerhazi, Aniko; Hiltensperger, Ramona; Kawhol, Wolfram; Kovacs, Attila Istvan; Rossler, Wulf; Slade, Mike; Pushner, Bernd; Sampogna, Gaia


Mario Luciano

Andrea Fiorillo

Carlotta Brandi

Matteo Di Vincenzo

Aniko Egerhazi

Ramona Hiltensperger

Wolfram Kawhol

Attila Istvan Kovacs

Wulf Rossler

Professor of Mental Health Recovery and Social Inclusion

Bernd Pushner

Gaia Sampogna


The present study aimed to assess: (1) whether a more active involvement of patients is associated with an improvement of clinical symptoms, global functioning, and quality-of-life; and (2) how patients’ satisfaction with clinical decisions can lead to better outcome after 1 year. Data were collected as part of the study ‘Clinical decision-making and outcome in routine care for people with severe mental illness (CEDAR)’, a longitudinal observational study, funded by the EuropeanCommission and carried out in six European countries. Patients’ inclusion criteria were: (a) aged between 18 and 60 years; (b) diagnosis of a severe mental illness of any kind according to the Threshold Assessment Grid (TAG) ≥ 5 and duration of illness ≥ 2 years; (c) expected contact with the local mental health service during the 12-month observation period; (d) adequate skills in the language of the host countries; and (e) the ability to provide written informed consent. The clinical decision-making styles of clinicians and the patient satisfaction with decisions were assessed using the Clinical Decision Making Style and the Clinical Decision Making Involvement and Satisfaction scales, respectively. Patients were assessed at baseline and 1 year after the recruitment. The sample consisted of 588 patients with severe mental illness, mainly female, with a mean age of 41.69 (±10.74) and a mean duration of illness of 12.5 (±9.27) years. The majority of patients were diagnosed with psychotic (45.75%) or affective disorders (34.01%). At baseline, a shared CDM style was preferred by 70.6% of clinicians and about 40% of patients indicated a high level of satisfaction with the decision and 31% a medium level of satisfaction. Higher participation in clinical decisions was associated with improved social functioning and quality-of-life, and reduced interpersonal conflicts, sense of loneliness, feelings of inadequacy, and withdrawal in friendships after 1 year (p < 0.05). Moreover, a higher satisfaction with decisions was associated with a better quality-of-life (p < 0.0001), reduced symptom severity (p < 0.0001), and a significantly lower illness burden associated with symptoms of distress (p < 0.0001), interpersonal difficulties (p < 0.0001), and problems in social roles (p < 0.05). Our findings clearly show that a higher involvement in and satisfaction of patients with clinical decision-making was associated with better outcomes. More efforts have to be made to increase the involvement of patients in clinical decision-making in routine care settings.


Luciano, M., Fiorillo, A., Brandi, C., Di Vincenzo, M., Egerhazi, A., Hiltensperger, R., …Sampogna, G. (2022). Impact of clinical decision-making participation and satisfaction on outcomes in mental health practice: results from the CEDAR European longitudinal study. International Review of Psychiatry, 34(7-8), 848-860.

Journal Article Type Article
Acceptance Date May 30, 2022
Online Publication Date Jun 21, 2022
Publication Date Jun 21, 2022
Deposit Date Jun 22, 2022
Journal International Review of Psychiatry
Print ISSN 0954-0261
Electronic ISSN 1369-1627
Publisher Informa Healthcare
Peer Reviewed Peer Reviewed
Volume 34
Issue 7-8
Pages 848-860
Keywords Psychiatry and Mental health
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