What is the current scope of research assessing patients' and clinicians' perspectives on clozapine treatment? A comprehensive scoping review.

Abstract

Clozapine is continuously underused. The existing systematic reviews addressing barriers to clozapine prescribing primarily focus on clinical staff's attitudes and perceived barriers to prescribing. However, a preliminary literature search revealed additional literature on the subject not previously included in systematic reviews, including literature on patient perspectives. A scoping review is warranted to map the scope of primary studies on patients' and/or clinicians' perspectives on clozapine treatment and to identify gaps in research. A scoping review was designed and reported in accordance with established guidelines for scoping reviews. The electronic databases Cochrane Library, CINAHL, Web of Science, PsycINFO, MEDLINE, EMBASE, Google Scholar and two grey literature databases were searched. Furthermore, citation tracking of selected studies was undertaken. We included primary, empirical studies reporting clinicians' and/or patients' perspectives on clozapine treatment. No limitation was set for the year of publication or type of primary study. Two researchers independently screened for studies, extracted the data and coded the content. Findings were summarised visually and narratively. 146 studies were included. Most studies reported on patients' or clinicians' perspectives on active clozapine treatment or on clinicians' perspectives on barriers to clozapine initiation in general. Three gaps in research were identified: (1) clozapine-eligible, yet clozapine-naïve, patients' attitudes towards clozapine commencement, (2) clinicians' reasons for clozapine withholding and perceived facilitators of clozapine treatment in specific patient-cases and (3) patient and clinician perspectives on clozapine discontinuation, continuation and rechallenge in specific patient cases. Research on clozapine perspectives tends to repeat itself. Future studies addressing the identified gaps in evidence could provide the insights needed to optimise clozapine utilisation.