Development of a patient decision aid prototype on the decision to continue, reduce or discontinue antipsychotic medication following remission of first-episode psychosis.

Abstract

Background: Shared decision-making is essential to patient-centred care, but remains underutilised in psychiatry, particularly when deciding whether to continue, reduce or stop antipsychotic medication after remission from first-episode psychosis (FEP). Existing decision aids do not fully address recovery goals such as autonomy, identity and social reintegration.

Aims: To co-develop a patient decision aid (PDA) prototype that supports individuals in making the decision to continue, reduce or stop antipsychotics following remission from FEP.

Method: We used a patient-centred design process informed by International Patient Decision Aid Standards (IPDAS), User Centered Design (UCD-11) and the CHIME framework. A multidisciplinary steering group - including individuals with lived experience, clinicians, and researchers - co-developed the PDA. Iterative feedback was collected from an external advisory group of patient partners, caregivers and healthcare providers (n = 7). Acceptability was evaluated with structured questionnaires.

Results: The final prototype, structured into five sections (decision overview, personal values, risks and benefits, planning and real-life experiences), demonstrated strong acceptability across stakeholders. Ratings improved with each iteration, with version 3 receiving near-perfect scores on clarity, usefulness and balance. Users described the tool as relatable and empowering. The inclusion of real-life stories and visual decision exercises were particularly valued. However, some clinicians expressed concerns about time constraints and workflow integration.

Conclusions: This recovery-oriented PDA prototype offers a practical, evidence-based resource to facilitate shared decision-making with respect to continuing, reducing or stopping antipsychotics after FEP. Although early feedback is promising, pilot testing is needed to evaluate its impact on decision quality, satisfaction and treatment outcomes.