What matters to patients? A systematic review of preferences for medication-associated outcomes in mental disorders

Objective: To investigate patients’ preferences for

outcomes associated with psychoactive medications.

Setting/design: Systematic review of stated

preference studies. No settings restrictions were

applied.

Participants/eligibility criteria: We included

studies containing quantitative data regarding the

relative value adults with mental disorders place on

treatment outcomes. Studies with high risk of bias

were excluded.

Primary and secondary outcome measures: We

restricted the scope of our review to preferences for

outcomes, including the consequences from, attributes

of, and health states associated with particular

medications or medication classes, and process

outcomes.

Results: After reviewing 11 215 citations, 16 studies

were included in the systematic review. These studies

reported the stated preferences from patients with

schizophrenia (n=9), depression (n=4), bipolar disorder

(n=2) and attention deficit hyperactive disorder (n=1).

The median sample size was 81. Side effects and

symptom outcomes outnumbered functioning and

process outcomes. Severe disease and hospitalisation

were reported to be least desirable. Patients with

schizophrenia tended to value disease states as higher

and side effects as lower, compared to other

stakeholder groups. In depression, the ability to cope

with activities was found to be more important than a

depressed mood, per se. Patient preferences could not

consistently be predicted from demographic or disease

variables. Only a limited number of potentially

important outcomes had been investigated. Benefits to

patients were not part of the purpose in 9 of the 16

studies, and in 10 studies patients were not involved

when the outcomes to present were selected.

Conclusions: Insufficient evidence exists on the

relative value patients with mental disorders place on

medication-associated outcomes. To increase patientcentredness

in decisions involving psychoactive drugs,

further research—with outcomes elicited from patients,

and for a larger number of conditions—should be

undertaken.