From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors

Ita Fitzgerald; Laura J. Sahm; Ian Maidment; Emma Wallace; Yaara Zisman-Ilani; Mikkel Hojlund; Sarah O'Dwyer; Ciara Ni Dhubhlaing; Erin K. Crowley; Jo Howe

doi:10.1093/schbul/sbaf058

From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors

Ita Fitzgerald, Laura J. Sahm, Ian Maidment, Emma Wallace, Yaara Zisman-Ilani, Mikkel Hojlund, Sarah O'Dwyer, Ciara Ni Dhubhlaing, Erin K. Crowley, Jo Howe

Research output: Contribution to journal › Review article › peer-review

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Abstract

Background: Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 1 of this two-part realist review aimed to understand the impact of structural and contextual factors on prescriber engagement in SDM within antipsychotic prescribing.

Study design: CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science and Google Scholar were searched for evidence to develop realist programme theories outlining
the relationship between macro-level contexts and their impact on prescriber behaviours.

Study results: From 106 included documents, five programme theories explaining relationships between (i) leadership and governance, (ii) workforce development and (iii) service delivery contexts and their impact on reducing prescriber engagement with behaviours required of SDM application were developed. No facilitative macro-level contexts were identified. Key mechanisms reducing prescriber engagement in desired behaviours include fear of individual blame for adverse outcomes and exposure to liability, pressure from service
environments to prioritise decreasing risk of harm, devaluing of experiential knowledge and beliefs that SDM conflicts with duties of beneficence and non-maleficence.

Conclusion: Even empirically efficacious interventions will be difficult to implement at scale within real-world settings due to misalignment with complex cultural, legal and professional realities prominent therein. Mechanisms responsible for reducing prescriber engagement in SDM should be the target of structural interventions necessary to support contextual integration into psychosis management. Part 2 outlines features of service delivery contexts, workforce development and technology that can increase prescriber engagement in SDM.

Original language	English
Article number	sbaf058
Pages (from-to)	916-932
Number of pages	17
Journal	Schizophrenia Bulletin
Volume	51
Issue number	4
Early online date	21 May 2025
DOIs	https://doi.org/10.1093/schbul/sbaf058
Publication status	Published - Jul 2025

Bibliographical note

Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/
licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Data Access Statement

All data analysis documents are included in the Supplementary Appendix included with this study.

Keywords

Antipsychotic Agents/therapeutic use
Decision Making, Shared
Humans
Psychotic Disorders/drug therapy

Access to Document

10.1093/schbul/sbaf058Licence: CC BY-NC 4.0

sbaf058
Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 13.6 MBLicence: CC BY-NC 4.0

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From idealist to realist - designing and implementing shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): a realist review (Part 2 - designing SDM interventions: optimising design and local implementation)
Fitzgerald, I., Howe, J., Maidment, I., Wallace, E., Zisman-Ilani, Y., Hojlund, M., O'Dwyer, S., Dhubhlaing, C. N., Crowley, E. & Sahm, L. J., 21 May 2025, In: Schizophrenia Bulletin. 51, 4, p. 932-948 17 p., sbaf059.
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Fitzgerald, I., Sahm, L. J., Maidment, I., Wallace, E., Zisman-Ilani, Y., Hojlund, M., O'Dwyer, S., Dhubhlaing, C. N., Crowley, E. K., & Howe, J. (2025). From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors. Schizophrenia Bulletin, 51(4), 916-932. Article sbaf058. https://doi.org/10.1093/schbul/sbaf058

Fitzgerald, Ita ; Sahm, Laura J. ; Maidment, Ian et al. / From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors. In: Schizophrenia Bulletin. 2025 ; Vol. 51, No. 4. pp. 916-932.

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title = "From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors",

abstract = "Background: Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 1 of this two-part realist review aimed to understand the impact of structural and contextual factors on prescriber engagement in SDM within antipsychotic prescribing.Study design: CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science and Google Scholar were searched for evidence to develop realist programme theories outliningthe relationship between macro-level contexts and their impact on prescriber behaviours.Study results: From 106 included documents, five programme theories explaining relationships between (i) leadership and governance, (ii) workforce development and (iii) service delivery contexts and their impact on reducing prescriber engagement with behaviours required of SDM application were developed. No facilitative macro-level contexts were identified. Key mechanisms reducing prescriber engagement in desired behaviours include fear of individual blame for adverse outcomes and exposure to liability, pressure from serviceenvironments to prioritise decreasing risk of harm, devaluing of experiential knowledge and beliefs that SDM conflicts with duties of beneficence and non-maleficence.Conclusion: Even empirically efficacious interventions will be difficult to implement at scale within real-world settings due to misalignment with complex cultural, legal and professional realities prominent therein. Mechanisms responsible for reducing prescriber engagement in SDM should be the target of structural interventions necessary to support contextual integration into psychosis management. Part 2 outlines features of service delivery contexts, workforce development and technology that can increase prescriber engagement in SDM.",

keywords = "Antipsychotic Agents/therapeutic use, Decision Making, Shared, Humans, Psychotic Disorders/drug therapy",

author = "Ita Fitzgerald and Sahm, {Laura J.} and Ian Maidment and Emma Wallace and Yaara Zisman-Ilani and Mikkel Hojlund and Sarah O'Dwyer and Dhubhlaing, {Ciara Ni} and Crowley, {Erin K.} and Jo Howe",

note = "Copyright {\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. ",

year = "2025",

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doi = "10.1093/schbul/sbaf058",

language = "English",

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Fitzgerald, I, Sahm, LJ, Maidment, I, Wallace, E, Zisman-Ilani, Y, Hojlund, M, O'Dwyer, S, Dhubhlaing, CN, Crowley, EK & Howe, J 2025, 'From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors', Schizophrenia Bulletin, vol. 51, no. 4, sbaf058, pp. 916-932. https://doi.org/10.1093/schbul/sbaf058

From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors. / Fitzgerald, Ita; Sahm, Laura J.; Maidment, Ian et al.
In: Schizophrenia Bulletin, Vol. 51, No. 4, sbaf058, 07.2025, p. 916-932.

Research output: Contribution to journal › Review article › peer-review

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T1 - From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors

AU - Fitzgerald, Ita

AU - Sahm, Laura J.

AU - Maidment, Ian

AU - Wallace, Emma

AU - Zisman-Ilani, Yaara

AU - Hojlund, Mikkel

AU - O'Dwyer, Sarah

AU - Dhubhlaing, Ciara Ni

AU - Crowley, Erin K.

AU - Howe, Jo

N1 - Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

PY - 2025/7

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N2 - Background: Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 1 of this two-part realist review aimed to understand the impact of structural and contextual factors on prescriber engagement in SDM within antipsychotic prescribing.Study design: CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science and Google Scholar were searched for evidence to develop realist programme theories outliningthe relationship between macro-level contexts and their impact on prescriber behaviours.Study results: From 106 included documents, five programme theories explaining relationships between (i) leadership and governance, (ii) workforce development and (iii) service delivery contexts and their impact on reducing prescriber engagement with behaviours required of SDM application were developed. No facilitative macro-level contexts were identified. Key mechanisms reducing prescriber engagement in desired behaviours include fear of individual blame for adverse outcomes and exposure to liability, pressure from serviceenvironments to prioritise decreasing risk of harm, devaluing of experiential knowledge and beliefs that SDM conflicts with duties of beneficence and non-maleficence.Conclusion: Even empirically efficacious interventions will be difficult to implement at scale within real-world settings due to misalignment with complex cultural, legal and professional realities prominent therein. Mechanisms responsible for reducing prescriber engagement in SDM should be the target of structural interventions necessary to support contextual integration into psychosis management. Part 2 outlines features of service delivery contexts, workforce development and technology that can increase prescriber engagement in SDM.

AB - Background: Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 1 of this two-part realist review aimed to understand the impact of structural and contextual factors on prescriber engagement in SDM within antipsychotic prescribing.Study design: CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science and Google Scholar were searched for evidence to develop realist programme theories outliningthe relationship between macro-level contexts and their impact on prescriber behaviours.Study results: From 106 included documents, five programme theories explaining relationships between (i) leadership and governance, (ii) workforce development and (iii) service delivery contexts and their impact on reducing prescriber engagement with behaviours required of SDM application were developed. No facilitative macro-level contexts were identified. Key mechanisms reducing prescriber engagement in desired behaviours include fear of individual blame for adverse outcomes and exposure to liability, pressure from serviceenvironments to prioritise decreasing risk of harm, devaluing of experiential knowledge and beliefs that SDM conflicts with duties of beneficence and non-maleficence.Conclusion: Even empirically efficacious interventions will be difficult to implement at scale within real-world settings due to misalignment with complex cultural, legal and professional realities prominent therein. Mechanisms responsible for reducing prescriber engagement in SDM should be the target of structural interventions necessary to support contextual integration into psychosis management. Part 2 outlines features of service delivery contexts, workforce development and technology that can increase prescriber engagement in SDM.

KW - Antipsychotic Agents/therapeutic use

KW - Decision Making, Shared

KW - Humans

KW - Psychotic Disorders/drug therapy

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DO - 10.1093/schbul/sbaf058

M3 - Review article

C2 - 40396340

SN - 0586-7614

VL - 51

SP - 916

EP - 932

JO - Schizophrenia Bulletin

JF - Schizophrenia Bulletin

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ER -

Fitzgerald I, Sahm LJ, Maidment I, Wallace E, Zisman-Ilani Y, Hojlund M et al. From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors. Schizophrenia Bulletin. 2025 Jul;51(4):916-932. sbaf058. Epub 2025 May 21. doi: 10.1093/schbul/sbaf058

From Idealist to Realist-Designing and Implementing Shared Decision-Making Interventions in the Choice of Antipsychotic Prescription in People Living with Psychosis (SHAPE): A Realist Review: Part 1 - Implementing Shared Decision-Making: Policy, Governance and System Factors

Abstract

Bibliographical note

Data Access Statement

Keywords

Access to Document

Other files and links

Fingerprint

Research output

From idealist to realist - designing and implementing shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): a realist review (Part 2 - designing SDM interventions: optimising design and local implementation)

Cite this