Abstract
BackgroundDespite well-known benefits of family involvement and interventions, gaps remain in their implementation in early intervention for psychosis. Guidelines have been developed for early psychosis services to bridge evidence-implementation gaps. Little attention has been paid to their nature, quality and recommendations regarding family involvement and interventions. We aimed to identify, describe, and appraise family-focused recommendations in Canadian early psychosis guidelines.MethodsWe conducted a systematic review (PROSPERO#CR042020208974), including Canadian guidelines/standards for first-episode psychosis/early intervention in psychosis, or for psychosis/schizophrenia with a section on first-episode psychosis/early intervention for psychosis. The search was conducted in Google and Google Advanced of 58 websites (April 2024). From each document, bibliographic information and family-focused recommendations were extracted. All family-focused recommendations were subject to content analysis and mapped against a patient and family engagement framework. All guidelines were appraised using Appraisal of Guidelines Research & Evaluation-Recommendation EXcellence (AGREE-REX), assessing rigor and implementability. Family-focused recommendations were rated on three AGREE-REX items. Findings were narratively synthesized.ResultsSeven documents were included, with five provincial early psychosis guidelines and two Canada-wide schizophrenia-spectrum guidelines. 96 family-focused recommendations were extracted covering 21 themes (19 appeared in ≤4 guidelines; two (family psychoeducation; involving families in treatment-planning) in five guidelines). No guidelines had recommendations regarding families in inpatient care; only two guidelines had recommendations for navigating consent vis-à-vis family involvement. 77.4% of recommendations were about direct care; 22.5% about involving families in organizational design/governance; and none about policymaking involvement. AGREE-REX ratings for relevant outcomes and local applicability were lower for family-focused recommendations than overall guidelines. Most guidelines fared poorly in eliciting families' values/preferences.ConclusionFew family-focused recommendations featured consistently across early psychosis guidelines. There was little guidance on navigating barriers to family involvement. Our analysis revealed critical gaps, including in viewing families as partners in treatment decision-making and services/policy design. Future guidelines must integrate stakeholders' values/preferences and guidance on real-world implementation.