Treatment options and shared decision-making in the treatment of opioid use disorder: A scoping review

Tyler Marshall; Myles Hancock; Elizabeth N Kinnard; Karin Olson; Adam Abba-Aji; Katherine Rittenbach; Jonathan N Stea; Robert Tanguay; Sunita Vohra

doi:10.1016/j.jsat.2021.108646

Treatment options and shared decision-making in the treatment of opioid use disorder: A scoping review

J Subst Abuse Treat. 2022 Apr:135:108646. doi: 10.1016/j.jsat.2021.108646. Epub 2021 Nov 12.

Authors

Tyler Marshall¹, Myles Hancock², Elizabeth N Kinnard³, Karin Olson⁴, Adam Abba-Aji¹, Katherine Rittenbach⁵, Jonathan N Stea⁶, Robert Tanguay⁷, Sunita Vohra⁸

Affiliations

¹ Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
² School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States of America.
⁴ Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
⁵ Addiction and Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada; Department of Psychology, University of Calgary, Alberta, Canada.
⁶ Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
⁷ Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: svohra@ualberta.ca.

PMID: 34810044
DOI: 10.1016/j.jsat.2021.108646

Abstract

Background: Shared decision-making (SDM) is an approach to clinical decision-making that includes patients' values and preferences during health-related decisions. Previous research suggests that SDM may be beneficial in the treatment of substance use disorders; however, the impact of SDM in the treatment of opioid use disorder (OUD) remains unclear.

Objectives: To identify relevant peer-reviewed literature related to SDM in the treatment of adults with OUD, and to summarize the main findings according to patient outcomes.

Methods: The research team conducted a scoping review. The team searched five electronic health databases from database inception until September 2019 using MeSH and keywords related to SDM. The team included only peer-reviewed studies where adults (≥18 years) with OUD were provided a choice and/or allowed input into their treatment plan. Two independent reviewers screened, extracted, and assessed the quality of included studies.

Results: Fourteen studies (n = 1748 participants) met inclusion criteria, including seven randomized controlled trials, three non-randomized controlled trials, two observational studies, and one qualitative study. Treatment options included: patient regulated methadone dosing vs. fixed dosing (n = 4 studies), optional vs. mandatory counseling (n = 4 studies), home vs. office buprenorphine inductions (n = 2 studies), and inpatient vs. outpatient treatment (n = 1 study). None of the studies measured SDM with a validated instrument. Seven of 14 studies reported at least one improved patient outcome.

Conclusions: The review found few studies that explored whether providing treatment options and/or encouraging participation in decision-making are beneficial for adults with OUD. Preliminary evidence suggests that SDM may be promising for this population. However, the field needs more research on person-centered care and SDM.

Keywords: Decision-making; Opioid-related disorders; Patient-centered care; Substance-related disorders.

Publication types

Review

MeSH terms

Adult
Clinical Decision-Making
Decision Making
Humans
Opioid-Related Disorders* / drug therapy
Patient Participation*