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Bruch JD, Khazen M, Mahmic-Kaknjo M, Légaré F, Ellen ME. The effects of shared decision making on health outcomes, health care quality, cost, and consultation time: An umbrella review. PATIENT EDUCATION AND COUNSELING 2024; 129:108408. [PMID: 39214045 DOI: 10.1016/j.pec.2024.108408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 08/18/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To review the effects of shared decision making (SDM) on health outcomes, health care quality, cost, and consultation time METHODS: We conducted an umbrella review and searched systematic reviews on SDM from PubMed, CINHAL, and Web of Science. We included reviews on SDM interventions used in a health care setting with patients. We assessed the eligibility of retrieved articles and evaluated whether the review addressed Consolidated Framework for Implementation Research (CFIR) characteristics. RESULTS Out of 3678 records, 48 reviews were included. Half of the reviews focused exclusively on RCT studies (n = 21). A little less than half were focused specifically on decision aids (n = 23). Thirty-two reviews discussed CFIR characteristics explicitly or implicitly; the majority of which were specific to intervention characteristics. Reviews tended to cluster around patient populations and tended to be low or critically low to moderate in their quality. Reviews of SDM on health outcomes, health care quality, cost, and consultation time were highly uncertain but often ranged from neutral to positive. CONCLUSIONS We observed that SDM implementation did not typically increase costs or increase consultation time while having some neutral to positive benefits on outcomes and quality for certain populations. Gaps in knowledge remain including better research on the climate where SDM is most effective.
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Affiliation(s)
- Joseph Dov Bruch
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Maram Khazen
- The Max Stern Yezreel Valley College, Emek Jezreel, Israel
| | - Mersiha Mahmic-Kaknjo
- Department of Clinical Pharmacology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina; Faculty of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Moriah E Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Institute of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.
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De las Cuevas C, Benadero O. Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients. Patient Prefer Adherence 2024; 18:1629-1640. [PMID: 39131691 PMCID: PMC11313499 DOI: 10.2147/ppa.s469579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024] Open
Abstract
Objective This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population. Methods A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings. Results Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes. Conclusion The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), University of La Laguna, La Laguna, Canary Islands, Spain
| | - Omaira Benadero
- School of Medicine of the University of La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
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Mat Lazim NH, Syed A, Lee C, Ahmed Abousheishaa A, Chong Guan N. Using decision support tools for treatment decision making about antidepressants in outpatient psychiatric consultations. PATIENT EDUCATION AND COUNSELING 2024; 124:108266. [PMID: 38565074 DOI: 10.1016/j.pec.2024.108266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine the use of decision support tools in decision making about antidepressants during conversations between patients with major depressive disorder (MDD) and their psychiatrists. METHODS Theme-oriented discourse analysis of two psychiatric consultation groups: control (n = 17) and intervention (n = 16). In the control group, only a doctor's conversation guide was used; in the intervention group, the conversation guide and a patient decision aid (PDA) were used. RESULTS Psychiatrists mainly dominated conversations in both consultation groups. They were less likely to elicit patient treatment-related perspectives in the intervention group as they focused more on delivering the information than obtaining patient perspectives. However, using PDA in the intervention group slightly encouraged patients to participate in decisional talk. CONCLUSION The decision support tools did promote SDM performance. Using the conversation guide in both consultation groups encouraged the elicitation of patient perspectives, which helped the psychiatrists in tailoring their recommendations of options based on patient preferences and concerns. Using the PDA in the intervention group created space for treatment discussion and fostered active collaboration in treatment decision making. PRACTICE IMPLICATIONS Our findings have implications for SDM communication skills training and critical reflection on SDM practice.
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Affiliation(s)
- Nor Hazila Mat Lazim
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Charity Lee
- Department of Asian and European Languages, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Aya Ahmed Abousheishaa
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Sgarbossa NJ, Alarcon-Ruiz CA, Kopitowski KS, Franco JV. Shared decision-making for supporting women's decisions about breast cancer screening. Cochrane Database Syst Rev 2024; 5:CD013822. [PMID: 38726892 PMCID: PMC11082933 DOI: 10.1002/14651858.cd013822.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND In breast cancer screening programmes, women may have discussions with a healthcare provider to help them decide whether or not they wish to join the breast cancer screening programme. This process is called shared decision-making (SDM) and involves discussions and decisions based on the evidence and the person's values and preferences. SDM is becoming a recommended approach in clinical guidelines, extending beyond decision aids. However, the overall effect of SDM in women deciding to participate in breast cancer screening remains uncertain. OBJECTIVES To assess the effect of SDM on women's satisfaction, confidence, and knowledge when deciding whether to participate in breast cancer screening. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 8 August 2023. We also screened abstracts from two relevant conferences from 2020 to 2023. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) and cluster-RCTs assessing interventions targeting various components of SDM. The focus was on supporting women aged 40 to 75 at average or above-average risk of breast cancer in their decision to participate in breast cancer screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and conducted data extraction, risk of bias assessment, and GRADE assessment of the certainty of the evidence. Review outcomes included satisfaction with the decision-making process, confidence in the decision made, knowledge of all options, adherence to the chosen option, women's involvement in SDM, woman-clinician communication, and mental health. MAIN RESULTS We identified 19 studies with 64,215 randomised women, mostly with an average to moderate risk of breast cancer. Two studies covered all aspects of SDM; six examined shortened forms of SDM involving communication on risks and personal values; and 11 focused on enhanced communication of risk without other SDM aspects. SDM involving all components compared to control The two eligible studies did not assess satisfaction with the SDM process or confidence in the decision. Based on a single study, SDM showed uncertain effects on participant knowledge regarding the age to start screening (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.61 to 2.28; 133 women; very low certainty evidence) and frequency of testing (RR 0.84, 95% CI 0.68 to 1.04; 133 women; very low certainty evidence). Other review outcomes were not measured. Abbreviated forms of SDM with clarification of values and preferences compared to control Of the six included studies, none evaluated satisfaction with the SDM process. These interventions may reduce conflict in the decision made, based on two measures, Decisional Conflict Scale scores (mean difference (MD) -1.60, 95% CI -4.21 to 0.87; conflict scale from 0 to 100; 4 studies; 1714 women; very low certainty evidence) and the proportion of women with residual conflict compared to control at one to three months' follow-up (rate of women with a conflicted decision, RR 0.75, 95% CI 0.56 to 0.99; 1 study; 1001 women, very low certainty evidence). Knowledge of all options was assessed through knowledge scores and informed choice. The effect of SDM may enhance knowledge (MDs ranged from 0.47 to 1.44 higher scores on a scale from 0 to 10; 5 studies; 2114 women; low certainty evidence) and may lead to higher rates of informed choice (RR 1.24, 95% CI 0.95 to 1.63; 4 studies; 2449 women; low certainty evidence) compared to control at one to three months' follow-up. These interventions may result in little to no difference in anxiety (MD 0.54, 95% -0.96 to 2.14; scale from 20 to 80; 2 studies; 749 women; low certainty evidence) and the number of women with worries about cancer compared to control at four to six weeks' follow-up (RR 0.88, 95% CI 0.73 to 1.06; 1 study, 639 women; low certainty evidence). Other review outcomes were not measured. Enhanced communication about risks without other SDM aspects compared to control Of 11 studies, three did not report relevant outcomes for this review, and none assessed satisfaction with the SDM process. Confidence in the decision made was measured by decisional conflict and anticipated regret of participating in screening or not. These interventions, without addressing values and preferences, may result in lower confidence in the decision compared to regular communication strategies at two weeks' follow-up (MD 2.89, 95% CI -2.35 to 8.14; Decisional Conflict Scale from 0 to 100; 2 studies; 1191 women; low certainty evidence). They may result in higher anticipated regret if participating in screening (MD 0.28, 95% CI 0.15 to 0.41) and lower anticipated regret if not participating in screening (MD -0.28, 95% CI -0.42 to -0.14). These interventions increase knowledge (MD 1.14, 95% CI 0.61 to 1.62; scale from 0 to 10; 4 studies; 2510 women; high certainty evidence), while it is unclear if there is a higher rate of informed choice compared to regular communication strategies at two to four weeks' follow-up (RR 1.27, 95% CI 0.83 to 1.92; 2 studies; 1805 women; low certainty evidence). These interventions result in little to no difference in anxiety (MD 0.33, 95% CI -1.55 to 0.99; scale from 20 to 80) and depression (MD 0.02, 95% CI -0.41 to 0.45; scale from 0 to 21; 2 studies; 1193 women; high certainty evidence) and lower cancer worry compared to control (MD -0.17, 95% CI -0.26 to -0.08; scale from 1 to 4; 1 study; 838 women; high certainty evidence). Other review outcomes were not measured. AUTHORS' CONCLUSIONS Studies using abbreviated forms of SDM and other forms of enhanced communications indicated improvements in knowledge and reduced decisional conflict. However, uncertainty remains about the effect of SDM on supporting women's decisions. Most studies did not evaluate outcomes considered important for this review topic, and those that did measured different concepts. High-quality randomised trials are needed to evaluate SDM in diverse cultural settings with a focus on outcomes such as women's satisfaction with choices aligned to their values.
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Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Victoria Ruiz Yanzi
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadia J Sgarbossa
- Health Department, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Karin S Kopitowski
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Va Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Verwijmeren D, Grootens KP. Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care. Community Ment Health J 2024; 60:292-307. [PMID: 37550559 PMCID: PMC10821819 DOI: 10.1007/s10597-023-01170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.
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Affiliation(s)
- Doris Verwijmeren
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands.
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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van der Heijden-Hobus IMW, Rosema BS, Vorstman JAS, Kas MJH, Franke SK, Boonstra N, Sommer IEC. Personal preferences for treatment and care during and after a First Episode Psychosis: A qualitative study. Early Interv Psychiatry 2023. [PMID: 38030570 DOI: 10.1111/eip.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/31/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM A first episode of psychosis (FEP) is a stressful, often life-changing experience. Scarce information is available about personal preferences regarding their care needs during and after a FEP. Whereas a more thorough understanding of these preferences is essential to aid shared decision-making during treatment and improve treatment satisfaction. METHODS Face-to-face interviews with participants in remission of a FEP were set up, addressing personal preferences and needs for care during and after a FEP. The interviews were conducted by a female and a male researcher, the latter being an expert with lived experience. RESULTS Twenty individuals in remission of a FEP were interviewed, of which 16 had been hospitalized. The distinguished themes based on personal preferences were tranquillity, peace and quietness, information, being understood, support from significant others, and practical guidance in rebuilding one's life. Our findings revealed that the need for information and the need to be heard were often not sufficiently met. For 16/20 participants, the tranquillity of inpatient treatment of the FEP was predominantly perceived as a welcome safe haven. The presence and support of family and close friends were mentioned as an important factor in the process of achieving remission. CONCLUSIONS The current exploratory study showed that patients were able to indicate their personal needs. Important findings are the need for information and the need to be heard. Interestingly, hospitalization was mostly seen as an opportunity to achieve tranquillity. More lived experience expertise is needed to elucidate the needs of individuals in the early phase of a FEP to aid people who are recovering from their first psychosis in rebuilding their lives again.
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Affiliation(s)
- Inge M W van der Heijden-Hobus
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Janssen-Cilag B.V., Breda, The Netherlands
| | - Bram-Sieben Rosema
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacob A S Vorstman
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- SickKids Research Institute & Genetics & Genome Biology Program, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martien J H Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Sigrid K Franke
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- NHL/Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, The Netherlands
| | - Iris E C Sommer
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Villena-Jimena A, Morales-Asencio JM, Quemada C, Hurtado MM. "It's That They Treated Me Like an Object": A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4614. [PMID: 36901624 PMCID: PMC10002244 DOI: 10.3390/ijerph20054614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.
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Affiliation(s)
- Amelia Villena-Jimena
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Casta Quemada
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - María M. Hurtado
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
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Huurman ME, Pijnenborg GHM, Sportel BE, van Rijsbergen GD, Hasson-Ohayon I, Boonstra N. Communicating diagnoses to individuals with a first episode psychosis: A qualitative study of individuals perspectives. Front Psychiatry 2023; 14:1098224. [PMID: 36873199 PMCID: PMC9980435 DOI: 10.3389/fpsyt.2023.1098224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Receiving the label of a psychotic disorder influences self-perception and may result in negative outcomes such as self-stigma and decreased self-esteem. The way the diagnosis is communicated to individuals may affect these outcomes. AIMS This study aims to explore the experiences and needs of individuals after a first episode of psychosis with regard to the way in which information about diagnosis, treatment options and prognosis is communicated with them. DESIGN AND METHODS A descriptive interpretative phenomenological approach was used. Fifteen individuals who experienced a first episode of psychosis participated in individual semi-structured open-ended interviews on their experiences and needs regarding the process of providing information about diagnosis, treatment options and prognosis. Inductive thematic analysis was used to analyze the interviews. RESULTS Four recurring themes where identified (1) timing (when); (2) content (what); and (3) the way information is provided (how). Individuals also reported that the provided information could elicit an emotional reaction, for which they would require specific attention, therefore the fourth theme is (4) reactions and feelings. CONCLUSION This study provides new insights into the experiences and specific information needed by individuals with a first episode of psychosis. Results suggest that individuals have different needs regarding the type of (what), how and when to receive information about diagnosis and treatment options. This requires a tailor-made process of communicating diagnosis. A guideline on when, how and what to inform, as well as providing personalized written information regarding the diagnosis and treatment options, is recommended.
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Affiliation(s)
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, Netherlands
| | - Bouwina Esther Sportel
- Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, Netherlands
| | | | | | - Nynke Boonstra
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands.,KieN VIP Mental Health Care Services, Leeuwarden, Netherlands.,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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10
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A systematic review of shared decision making interventions in child and youth mental health: synthesising the use of theory, intervention functions, and behaviour change techniques. Eur Child Adolesc Psychiatry 2023; 32:209-222. [PMID: 33890174 PMCID: PMC9970944 DOI: 10.1007/s00787-021-01782-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
Reviews around interventions to improve shared decision making (SDM) for child and youth mental health have produced inconclusive findings on what approaches increase participation. Importantly, the previous reviews did not explore the use of theory, as well as mechanisms of change (intervention functions) and active units of change (behaviour change techniques). The aim of this review was to explore these factors and ascertain how, if at all, these contribute to SDM. Five databases were searched up until April 2020. Studies met inclusion criteria if they were: (a) an intervention to facilitate SDM; (b) aimed at children, adolescence, or young people aged up to 25, with a mental health difficulty, or their parents/guardians; and (c) included a control group. Data were extracted on patient characteristics, study design, intervention, theoretical background, intervention functions, behaviour change techniques, and SDM. Quality assessment of the studies was undertaken using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Eight different interventions met inclusion criteria. The role of theory to increase SDM remains unclear. Specific intervention functions, such as 'education' on SDM and treatment options and 'environmental restructuring' using decision aids, are being used in SDM interventions, as well as 'training' for clinicians. Similarly, behaviour change techniques linked to these, such as 'adding objects to the environment', 'discussing pros/cons', and clinicians engaging in 'behavioural practice/rehearsal'. However, as most studies scored low on the quality assessment criteria, as well as a small number of studies included and a low number of behaviour change techniques utilised, links between behaviour change techniques, intervention functions and increased participation remain tentative. Intervention developers and clinicians may wish to consider specific intervention functions and behaviour change techniques to facilitate SDM.
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11
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Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11:CD007297. [PMID: 36367232 PMCID: PMC9650912 DOI: 10.1002/14651858.cd007297.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. OBJECTIVES To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. SEARCH METHODS We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. MAIN RESULTS This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. AUTHORS' CONCLUSIONS This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukari Yaju
- Department of Epidemiology and Biostatistics for Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Leigh Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, The University of Stirling, Scotland, UK
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12
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Christensen TN, Poulsen CH, Ebersbach BK, Eplov LF. Integrated mental health care and vocational rehabilitation intervention to improve return to work rates for people on sick leave due to common mental and functional disorders (IBBIS-II)-a study protocol for a randomized clinical trial. Trials 2022; 23:820. [PMID: 36175977 PMCID: PMC9522440 DOI: 10.1186/s13063-022-06718-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness has an estimated financial burden on the Danish economy of 3.4% of the gross national product every year due to lost productivity, social benefits, and healthcare costs, and approximately 50% of people receiving long-term sickness benefits have a common mental illness. Furthermore, a significant treatment gap exists where less than 30% are treated for their mental illness. The primary objective of the randomized trial is to examine whether people on sick leave with a diagnosis of anxiety, depression, stress, personality disorders, or functional disorders return to work faster and have higher job retention if they receive an integrated and optimized vocational rehabilitation and mental health care intervention, compared to people who receive the standard mental health care and vocational rehabilitation service. METHODS The trial is designed as an investigator-initiated, randomized, two-group parallel, assessor-blinded, superior trial. A total of 900 participants with a common mental illness will randomly be assigned into two groups: (1) IBBIS-II, consisting of integrated mental health care and vocational rehabilitation, or (2) service as usual (SAU), at two sites in Denmark. The primary outcome is the difference between the two groups in time to return to work (RTW) at 12 months using data from the Danish Register for Evaluation of Marginalization (DREAM) database. DISCUSSION This study will contribute with new knowledge on vocational recovery and integrated vocational and health care interventions in a Scandinavian context. TRIAL REGISTRATION ClinicalTrials.gov NCT04432129 . Registered on June 16, 2020.
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Affiliation(s)
- Thomas Nordahl Christensen
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen, Denmark.
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Bea Kolbe Ebersbach
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen, Denmark
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13
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Oedegaard CH, Ruano AL, Blindheim A, Veseth M, Stige B, Davidson L, Engebretsen IMS. How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway. Int J Ment Health Syst 2022; 16:19. [PMID: 35379290 PMCID: PMC8978409 DOI: 10.1186/s13033-022-00529-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work. Trial registration: N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00529-8.
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14
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Moljord IEO, Stensvåg KG, Halsteinli V, Rise MB. Self-referral to inpatient treatment program in a community mental health Centre in Central Norway: investigating the implementation, professionals' experiences and costs. BMC Health Serv Res 2021; 21:1310. [PMID: 34872531 PMCID: PMC8647338 DOI: 10.1186/s12913-021-07273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-referral to inpatient treatment (SRIT) is built on user participation and patient autonomy. SRIT was conducted for patients with severe mental disorders in a Norwegian Community Mental Health Centre. The aims of the present study were to describe the implementation of SRIT, explore the professionals' experiences of SRIT and assess the costs entailed. METHODS Qualitative document analysis, interviews with professionals and quantitative analysis of register data from a randomized controlled trial were used. RESULTS SRIT seemed to be implemented as intended. According to the professionals, SRIT allowed the patients to cope, be empowered, more active and responsible. Some professionals experienced increased responsibility for patients' medication and for assessing health and suicide risks. SRIT did not reduce hospital costs. The professionals were satisfied with nurse-led SRIT treatment. CONCLUSIONS SRIT appears to be a high-quality mental health service that empowers and activates patients. Nurse-led treatment may entail more efficient use of professional resources. In future implementations of SRIT, the efficient use of service resources and the administration of beds should be investigated. More flexible availability should be considered in line with the intentions behind SRIT, as well as ensuring adequate professional training in assessing health and suicide risk.
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Affiliation(s)
- Inger Elise Opheim Moljord
- Department of Research, Innovation and Education, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Nidaros Community Mental Health Centre, Clinic of Psychiatry, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kine Gabrielsen Stensvåg
- Nidaros Community Mental Health Centre, Clinic of Psychiatry, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Halsteinli
- Regional Centre for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit By Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Yu CH, Medleg F, Choi D, Spagnuolo CM, Pinnaduwage L, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi S, Stacey D, Telner D. Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial. BMC Med Inform Decis Mak 2021; 21:323. [PMID: 34809626 PMCID: PMC8609876 DOI: 10.1186/s12911-021-01673-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01673-w.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Farid Medleg
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Catherine M Spagnuolo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Lakmini Pinnaduwage
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Paul Cantarutti
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada
| | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada
| | - Amy Hoang-Kim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Noah Ivers
- Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - David Kaplan
- University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.,North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada
| | - Fok-Han Leung
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - John Maxted
- Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada
| | - Jeremy Rezmovitz
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sumeet Sodhi
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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17
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Zisman-Ilani Y, Chmielowska M, Dixon LB, Ramon S. NICE shared decision making guidelines and mental health: challenges for research, practice and implementation. BJPsych Open 2021; 7:e154. [PMID: 34470688 PMCID: PMC8444056 DOI: 10.1192/bjo.2021.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, USA
| | - Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, USA
| | - Shulamit Ramon
- Department of Allied Health, Midwifery and Social Work, University of Hertfordshire, UK
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18
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Millard E, Medlicott E, Cardona J, Priebe S, Carr C. Preferences for group arts therapies: a cross-sectional survey of mental health patients and the general population. BMJ Open 2021; 11:e051173. [PMID: 34373313 PMCID: PMC8354273 DOI: 10.1136/bmjopen-2021-051173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The arts therapies include music therapy, dance movement therapy, art therapy and dramatherapy. Preferences for art forms may play an important role in engagement with treatment. This survey was an initial exploration of who is interested in group arts therapies, what they would choose and why. DESIGN An online cross-sectional survey of demographics, interest in and preferences for the arts therapies was designed in collaboration with patients. The survey took 10 min to complete, including informed consent and 14 main questions. Summary statistics, multinomial logistic regression and thematic analysis were used to analyse the data. SETTING Thirteen National Health Service mental health trusts in the UK asked mental health patients and members of the general population to participate. PARTICIPANTS A total of 1541 participants completed the survey; 685 mental health patients and 856 members of the general population. All participants were over 18 years old, had capacity to give informed consent and sufficient understanding of English. Mental health patients had to be using secondary mental health services. RESULTS Approximately 60% of participants would be interested in taking part in group arts therapies. Music therapy was the most frequent choice among mental health patients (41%) and art therapy was the most frequent choice in the general population (43%). Past experience of arts therapies was the most important predictor of preference for that same modality. Expectations of enjoyment, helpfulness, feeling capable, impact on mood and social interaction were most often reported as reasons for preferring one form of arts therapy. CONCLUSIONS Large proportions of the participants expressed an interest in group arts therapies. This may justify the wide provision of arts therapies and the offer of more than one modality to interested patients. It also highlights key considerations for assessment of preferences in the arts therapies as part of shared decision-making.
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Affiliation(s)
- Emma Millard
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | | | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Catherine Carr
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
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19
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Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the Digital Age: A Blessing or a Curse? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8302. [PMID: 34444055 PMCID: PMC8391902 DOI: 10.3390/ijerph18168302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.
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Affiliation(s)
- Carl B. Roth
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Andreas Papassotiropoulos
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Biozentrum, Life Sciences Training Facility, University of Basel, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
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20
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Johnston JN, Ridgway L, Cary-Barnard S, Allen J, Sanchez-Lafuente CL, Reive B, Kalynchuk LE, Caruncho HJ. Patient oriented research in mental health: matching laboratory to life and beyond in Canada. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:21. [PMID: 33902751 PMCID: PMC8074277 DOI: 10.1186/s40900-021-00266-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/30/2021] [Indexed: 05/19/2023]
Abstract
As patient-oriented research gains popularity in clinical research, the lack of patient input in foundational science grows more evident. Research has shown great utility in active partnerships between patient partners and scientists, yet many researchers are still hesitant about listening to the voices of those with lived experience guide and shape their experiments. Mental health has been a leading area for patient movements such as survivor-led research, however the stigma experienced by these patients creates difficulties not present in other health disciplines. The emergence of COVID-19 has also created unique circumstances that need to be addressed. Through this lens, we have taken experiences from our patient partners, students, and primary investigator to create recommendations for the better facilitation of patient-oriented research in foundational science in Canada. With these guidelines, from initial recruitment and leading to sustaining meaningful partnerships, we hope to encourage other researchers that patient-oriented research is necessary for the future of mental health research and foundational science.
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Affiliation(s)
- Jenessa N Johnston
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Lisa Ridgway
- Patient Partner, BC SUPPORT Unit, Victoria, BC, Canada
| | | | - Josh Allen
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | | | - Brady Reive
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Lisa E Kalynchuk
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Hector J Caruncho
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
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21
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Hopwood M. The Shared Decision-Making Process in the Pharmacological Management of Depression. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:23-30. [PMID: 31544218 PMCID: PMC6957572 DOI: 10.1007/s40271-019-00383-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Shared decision making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. There is an international consensus across medicine about the importance of SDM interventions, which have raised great interest in mental healthcare over the last decade. Yet SDM is not widely adopted, particularly in the field of psychiatry. The purpose of the present article is to examine, from a patient and physician perspective, the importance of SDM in the management of healthcare with a focus on mental health; it reviews the enablers and barriers (and how to overcome them) to implementing a SDM process in psychiatric practice. SDM models have been developed recently for involving patients with depression in the decision-making process, which could result in augmenting the proportion of patients who adhere to their antidepressant or other treatments for a duration that complies with the current recommendations. To implement this approach, more physicians need training in the SDM approach and access to appropriate tools that help engage in collaborative deliberation, and practice generally needs to be reorganized around the principles of patient engagement.
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Affiliation(s)
- Malcom Hopwood
- Albert Road Clinic, University of Melbourne, Melbourne, Australia.
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22
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Zisman-Ilani Y, Hurford I, Bowen A, Salzer M, Thomas EC. Evaluating the feasibility of a decision aid to promote shared decision making among young adults with first-episode psychosis: protocol for a pilot study. Pilot Feasibility Stud 2021; 7:22. [PMID: 33431018 PMCID: PMC7798319 DOI: 10.1186/s40814-020-00757-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. METHODS A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3- and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics. DISCUSSION This protocol outlines the methodology for a feasibility pilot comparing the effect of a novel SDM Antipsychotic Medication encounter DA with treatment as usual on SDM, medication adherence, and service engagement in FEP care. SDM is endorsed as a framework for use in FEP and antipsychotic pharmacotherapy, but its impact on adherence and health outcomes is unclear. Understanding the potential contribution of an SDM Antipsychotic Medication DA compared with usual care in psychosis pharmacotherapy is critical. The study will help answer several key questions new to SDM research, including the contribution of personality and clinical relationships to SDM in mental health and psychosis in particular. The study will serve to gather feasibility data to inform future studies and scale-up. TRIAL REGISTRATION Ethics approval was obtained through Temple University's institutional review board (IRB) and the City of Philadelphia's Department of Public Health IRB. The study has been retrospectively registered with ClinicalTrials.gov as NCT04373590 on 29 April 2020. https://clinicaltrials.gov/ct2/show/NCT04373590?term=NCT04373590&draw=2&rank=1.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Irene Hurford
- Psychosis Education, Assessment, Care and Empowerment (PEACE), Horizon House, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Bowen
- Psychosis Education, Assessment, Care and Empowerment (PEACE), Horizon House, Philadelphia, PA, USA
| | - Mark Salzer
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Elizabeth C Thomas
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA
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23
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Vitger T, Korsbek L, Austin SF, Petersen L, Nordentoft M, Hjorthøj C. Digital Shared Decision-Making Interventions in Mental Healthcare: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:691251. [PMID: 34552514 PMCID: PMC8450495 DOI: 10.3389/fpsyt.2021.691251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Shared decision-making (SDM) in mental healthcare has received increased attention as a process to reinforce person-centered care. With the rapid development of digital health technology, researchers investigate how digital interventions may be utilized to support SDM. Despite the promise of digital interventions to support SDM, the effect of these in mental healthcare has not been evaluated before. Thus, this paper aims to assess the effect of SDM interventions complimented by digital technology in mental healthcare. Objective: The objective of this review was to systematically examine the effectiveness of digital SDM interventions on patient outcomes as investigated in randomized trials. Methods: We performed a systematic review and meta-analysis of randomized controlled trials on digital SDM interventions for people with a mental health condition. We searched for relevant studies in MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. The search strategy included terms relating to SDM, digital systems, mental health conditions, and study type. The primary outcome was patient activation or indices of the same (e.g., empowerment and self-efficacy), adherence to treatment, hospital admissions, severity of symptoms, and level of functioning. Secondary outcomes were satisfaction, decisional conflict, working alliance, usage, and adherence of medicine; and adverse events were defined as harms or side effects. Results: Sixteen studies met the inclusion criteria with outcome data from 2,400 participants. Digital SDM interventions had a moderate positive effect as compared with a control condition on patient activation [standardized mean difference (SMD) = 0.56, CI: 0.10, 1.01, p = 0.02], a small effect on general symptoms (SMD = -0.17, CI: -0.31, -0.03, p = 0.02), and working alliance (SMD = 0.21, CI: 0.02, 0.41, p = 0.03) and for improving decisional conflict (SMD = -0.37, CI: -0.70, -0.05, p = 0.02). No effect was found on self-efficacy, other types of mental health symptoms, adverse events, or patient satisfaction. A total of 39 outcomes were narratively synthesized with results either favoring the intervention group or showing no significant differences between groups. Studies were generally assessed to have unclear or high risk of bias, and outcomes had a Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of low- or very low-quality evidence. Conclusions: Digital interventions to support SDM may be a promising tool in mental healthcare; but with the limited quality of research, we have little confidence in the estimates of effect. More quality research is needed to further assess the effectiveness of digital means to support SDM but also to determine which digital intervention features are most effective to support SDM. Systematic Review Registration: PROSPERO, identifier CRD42020148132.
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Affiliation(s)
- Tobias Vitger
- Competence Center for Rehabilitation and Recovery, Mental Health Center Ballerup, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
| | - Lisa Korsbek
- The Mental Health Centre Odense, Mental Health Services in the Region of Southern Denmark, Esbjerg, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Lone Petersen
- Competence Center for Rehabilitation and Recovery, Mental Health Center Ballerup, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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24
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Simmons MB, Brushe M, Elmes A, Polari A, Nelson B, Montague A. Shared Decision Making With Young People at Ultra High Risk of Psychotic Disorder. Front Psychiatry 2021; 12:683775. [PMID: 34603094 PMCID: PMC8481955 DOI: 10.3389/fpsyt.2021.683775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/31/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: While the majority of young people who meet the criteria for being considered at increased risk of psychosis do not go on to develop a psychotic disorder, young people are currently being identified and treated in early intervention services. Ethical concerns have been raised concerning the decision about whether or not to provide treatment, and if so, what type of treatment. This study sought to support young people themselves to make these decisions with support from their clinician through a shared decision-making approach, facilitated by an online decision aid. Methods: This project used the International Patient Decision Aid Standards (IPDAS) to guide the development and piloting of an online decision aid across two phases: (1) qualitative, semi-structured focus groups with young people who were past clients and clinicians from an early psychosis service; and (2) pilot testing of the decision aid with clinicians and young people who were current clients to finalize the development. Results: Issues discussed by clinicians in the focus group were grouped into three main areas: (1) engagement phase; (2) assessment and priorities for treatment; and (3) initial and ongoing decision making. Clients focused on the context in which the decisions were made, including as they experienced initial feelings of resistance, and then acceptance of efforts made to describe and treat their mental health challenges. Clients highlighted the need for collaboration between themselves and their clinician, and the need to be equipped with the knowledge and tools to take care of themselves. These focus group data were used to refine the online decision aid. Pilot testing revealed that while it was overall useful and relevant, important limitations were noted by both clients and clinicians. Discussion: The use of a decision aid to facilitate shared decision making (SDM) in this area is feasible and has utility for both clients and clinicians. Use of such a tool can help to address the need to uphold the rights of young people as decision makers about their own care. Future efforts should embed decision aids within complex SDM interventions, and research to understand issues relating to implementation of these interventions.
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Affiliation(s)
- Magenta Bender Simmons
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mary Brushe
- Telethon Kids Institute, University of Western Australia, Adelaide, SA, Australia.,School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Aurora Elmes
- Centre for Social Impact, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alice Montague
- North East London Foundation NHS Trust, London, United Kingdom.,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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25
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Kopitowski KS, Franco JVA. Shared decision making for supporting women’s decisions about breast cancer screening. Hippokratia 2020. [DOI: 10.1002/14651858.cd013822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - M. Victoria Ruiz Yanzi
- Family and Community Medicine; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | | | - Karin S Kopitowski
- Family and Community Medicine Division; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Juan VA Franco
- Associate Cochrane Centre; Instituto Universitario Hospital Italiano de Buenos Aires; Buenos Aires Argentina
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26
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Haugom EW, Stensrud B, Beston G, Ruud T, Landheim AS. Mental health professionals' experiences with shared decision-making for patients with psychotic disorders: a qualitative study. BMC Health Serv Res 2020; 20:1093. [PMID: 33246451 PMCID: PMC7694931 DOI: 10.1186/s12913-020-05949-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient's preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals' experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals' SDM experiences with patients with psychotic disorders. METHODS Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. RESULTS Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. CONCLUSION Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.
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Affiliation(s)
- Espen W Haugom
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P. B 104, 2381, Brumunddal, Norway. .,Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.
| | - Bjørn Stensrud
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P. B 104, 2381, Brumunddal, Norway.,Innlandet Hospital Trust, Division of Mental Health, P.B 104, 2381, Brumunddal, Norway
| | - Gro Beston
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P. B 104, 2381, Brumunddal, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P. B 104, 2381, Brumunddal, Norway.,Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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27
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Fattori F, O'Donnell D, Rodríguez-Martín B, Kroll T. Which instruments are used to measure shared, supported and assisted healthcare decision-making between patients who have limited, impaired or fluctuating capacity, their family carers and healthcare professionals? A systematic review protocol. HRB Open Res 2020; 2:19. [PMID: 33880427 PMCID: PMC8039860 DOI: 10.12688/hrbopenres.12932.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient’s values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined “Assisted” in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity. Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals. Methods: A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments. Discussion: The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals. Registration: PROSPERO
CRD42018105360; registered on 10/08/2018.
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Affiliation(s)
- Francesco Fattori
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Fisher A, Manicavasagar V, Sharpe L, Laidsaar‐powell R, Juraskova I. Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alana Fisher
- School of Psychology, University of Sydney,
- Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), University of Sydney,
| | - Vijaya Manicavasagar
- School of Psychiatry, University of New South Wales,
- Black Dog Institute, University of New South Wales,
| | | | - Rebekah Laidsaar‐powell
- School of Psychology, University of Sydney,
- Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), University of Sydney,
| | - Ilona Juraskova
- School of Psychology, University of Sydney,
- Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), University of Sydney,
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Aoki Y. Shared decision making for adults with severe mental illness: A concept analysis. Jpn J Nurs Sci 2020; 17:e12365. [PMID: 32761783 PMCID: PMC7590107 DOI: 10.1111/jjns.12365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 06/27/2020] [Indexed: 12/01/2022]
Abstract
AIM Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. METHODS Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. RESULTS Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship. CONCLUSIONS Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
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Affiliation(s)
- Yumi Aoki
- Psychiatric & Mental Health Nursing, Graduate School of NursingSt. Luke's International UniversityTokyoJapan
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30
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Shillington AC, Langenecker SA, Shelton RC, Foxworth P, Allen L, Rhodes M, Pesa J, Williamson D, Rovner MH. Development of a patient decision aid for treatment resistant depression. J Affect Disord 2020; 275:299-306. [PMID: 32734922 DOI: 10.1016/j.jad.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/12/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Shared decision-making (SDM) involves patients and clinicians choosing treatment jointly. SDM in mental health is hampered by lack of well-developed supporting tools. We describe an evidence-based patient decision aid (PDA) to facilitate SDM for treatment-resistant depression (TRD) following US National Quality Forum standards which are based upon the International Patient Decision Aid Standards (IPDAS). METHODS A web-based PDA was developed by a multidisciplinary steering committee of clinicians, patient advocates, patients and a decision scientist. Development included creating content consistent with decision-making domains that are impacted by patient preference in TRD. Development was guided by literature review, group conference calls/discussions, patient and clinician interviews (N = 8), high and lower literacy focus groups (N = 11) and pilot study (N = 5). The PDA presents risk-benefit information on domains (e.g., effectiveness, mode of administration, side effects, cost) and includes values clarification exercises. Pilot study patients were administered the Decisional Conflict Scale (DCS) and Decision Self-Efficacy Scale (DSES) prior to and following PDA interaction and clinician SDM. RESULTS During the pilot, prior to PDA interaction, mean (standard deviation) DCS score was 42.2 (14.4) and DSES score was 86.0 (14.6) out of 100. Following PDA interaction and SDM, DCS decreased (improved) to 28.1 (SD 4.1) and DSES increased to 95.5 (6.7). All patients endorsed that the PDA helped them to: recognize pros and cons of options; understand how treatments were administered, possible side-effects, and likelihood of benefit; recognize what was important relative to the decision; organize thoughts and prepare for a discussion with their clinician. CONCLUSIONS This PDA may support SDM in TRD. A future trial to determine impact of the present SMD on decision-making quality is warranted. It also highlights gaps in comparative effectiveness trials that could guide equitable shared decision-making.
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Affiliation(s)
| | | | | | | | - Luis Allen
- Advent Health Neuroscience Institute, Florida State University.
| | - Martha Rhodes
- Author - 3,000 Pulses Later: A Memoir of Surviving Depression Without Medication
| | - Jacqueline Pesa
- Population Health Research Real World Value & Evidence, Janssen Scientific Affairs, LLC.
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31
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Knutsson O, Schön UK. Co-creating a process of user involvement and shared decision-making in coordinated care planning with users and caregivers in social services. Int J Qual Stud Health Well-being 2020; 15:1812270. [PMID: 32940581 PMCID: PMC7534304 DOI: 10.1080/17482631.2020.1812270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Although user participation and shared decision-making in formal statutory coordinated care planning are described as central, they remain to be implemented. The aim of this study is to explore how collaboration and shared decision-making in the social services can be realized in formal care planning activities with people with mental disabilities. Methods We conducted eight workshops with 12 users and 17 caregivers to investigate existing barriers to and possible solutions for participation in coordinated care planning. Results Workshop formats and techniques from participatory design generated rich research materials illustrating challenges currently experienced by users and caregivers in care planning work, as well as a large variety of solutions to these challenges. They also illustrated differences in how participation is understood and the conditions required to realize shared decision-making between users and caregivers. Conclusions An improved coordinated individual plan (CIP) process emerged, based on the active participation of users and caregivers. This process is a familiar and transparent process for users and caregivers, reflecting the needs and preferences of users at all stages. It requires careful preparation and collaboration with the users, as well as caregiver flexibility.
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Affiliation(s)
- Ola Knutsson
- Department of Computer and Systems Sciences, Stockholm University , Stockholm, Sweden
| | - Ulla-Karin Schön
- Department of Social Work, Stockholm University , Stockholm, Sweden
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Hausheer AC, Suter LC, Kool J. Shared decision-making in physical therapy: a cross-sectional observational study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1772869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andrea Claudia Hausheer
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
- Research Department, Rehabilitation Centre Valens, Valens, Switzerland
| | - Larissa Carolina Suter
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
- Research Department, Rehabilitation Centre Valens, Valens, Switzerland
| | - Jan Kool
- Research Department, Rehabilitation Centre Valens, Valens, Switzerland
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Drivenes K, Haaland VØ, Hauge YL, Vederhus JK, Irgens AC, Solli KK, Regevik H, Falk RS, Tanum L. Discrepancy in Ratings of Shared Decision Making Between Patients and Health Professionals: A Cross Sectional Study in Mental Health Care. Front Psychol 2020; 11:443. [PMID: 32265780 PMCID: PMC7108784 DOI: 10.3389/fpsyg.2020.00443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background A defined goal in mental health care is to increase the opportunities for patients to more actively participate in their treatment. This goal includes integrating aspects of user empowerment and shared decision-making (SDM) into treatment courses. To achieve this goal, more knowledge is needed about how patients and therapists perceive this integration. Objective To explore patient experiences of SDM, to describe differences between patient and therapist experiences, and to identify patient factors that might reduce SDM experiences for patients compared to the experiences of their therapists. Methods This cross-sectional study included 992 patients that had appointments with 267 therapists at Sørlandet Hospital, Division of Mental Health during a 1-week period. Both patients and therapists completed the CollaboRATE questionnaire, which was used to rate SDM experiences. Patients reported demographic and treatment-related information. Therapists provided clinical information. Results The analysis included 953 patient-therapist responder pairs that completed the CollaboRATE questionnaire. The mean SDM score was 80.7 (SD 20.8) among patients, and 86.6 (SD 12.1) among therapists. Females and patients that did not use medication for mental health disorders reported higher SDM scores than males and patients that used psychiatric medications (83.3 vs. 77.7; p < 0.001 and 82.6 vs. 79.8; p = 0.03, respectively). Patients with diagnoses involving psychotic symptoms reported lower SDM scores than all the other patients (66.8 vs. 82.3; p < 0.001). The probability that a patient would report lower SDM scores than their therapist was highest among patients that received involuntary treatment (OR 3.2, p = 0.02), patients with treatment durations longer than 2.2 years (OR 1.9, p = 0.001), and patients that required day care or in-patient care (OR 3.2, p = 0.01 and OR 3.2, p < 0.001, respectively). Conclusion We showed that both therapists and patients reported good SDM experiences in decisional situations, which indicated that SDM was implemented well. However, the SDM scores reported by in-patients and patients with prolonged or involuntary treatments were significantly lower than scores reported by their therapists. Our findings suggested that it remains a struggle in mental health care to establish a common understanding between patients and therapists in decisional processes regarding treatments for some patient groups.
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Affiliation(s)
- Karin Drivenes
- Sørlandet Hospital, Kristiansand, Norway.,Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
| | - Vegard Ø Haaland
- Sørlandet Hospital, Kristiansand, Norway.,Clinical Neuroscience Research Group, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Yina L Hauge
- Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
| | | | | | - Kristin Klemmetsby Solli
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of R&D in Mental Health, Akershus University Hospital, L renskog, Norway.,OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hilde Regevik
- Sørlandet Hospital, Kristiansand, Norway.,Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
| | - Ragnhild S Falk
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Lars Tanum
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
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Roze KCM, Tijsseling C, Rudd B, Tiemens BG. Measuring Recovery in Deaf, Hard-of-Hearing, and Tinnitus Patients in a Mental Health Care Setting: Validation of the I.ROC. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2020; 25:178-187. [PMID: 31799612 PMCID: PMC7082535 DOI: 10.1093/deafed/enz043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/29/2019] [Accepted: 10/11/2019] [Indexed: 05/15/2023]
Abstract
This study was aimed at validating the Individual Recovery Outcomes Counter (I.ROC) for deaf, hard-of-hearing, and tinnitus patients in a mental health care setting. There is a need for an accessible instrument to monitor treatment effects in this population. The I.ROC measures recovery, seeing recovery as a process of experiencing a meaningful life, despite the limitations caused by illness or disability. A total of 84 adults referred to 2 specialist mental health centers for deaf, hard-of-hearing, and tinnitus adults in the Netherlands completed the Dutch version of I.ROC and 3 other instruments. A total of 25 patients refused or did not complete the instruments: 50% of patients using sign language and 18% of patients using spoken language. Participants completed the measures at intake and then every 3 months. In this sample I.ROC demonstrated good internal consistency and convergent validity. Sensitivity to change was good, especially over a period of 6 or 9 months. This study provides preliminary evidence that the I.ROC is a valid instrument measuring recovery for hard-of-hearing and tinnitus patients using spoken language. For deaf patients using sign language, specifically those with limited language skills in spoken and written Dutch, more research is needed.
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Affiliation(s)
- Karin C M Roze
- Pro Persona de Riethorst Mental Health Care Centre for Deaf and Hard of Hearing
- Pro Persona Research
- Correspondence should be sent to Karin CM Roze ()
| | - Corrie Tijsseling
- GGMD Mental Health Care and Social Work for Deaf and Hard of Hearing people
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Rodenburg-Vandenbussche S, Carlier I, van Vliet I, van Hemert A, Stiggelbout A, Zitman F. Patients' and clinicians' perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders, and obsessive-compulsive disorder in specialized psychiatric care. J Eval Clin Pract 2020; 26:645-658. [PMID: 31612578 DOI: 10.1111/jep.13285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES People worldwide are affected by psychiatric disorders that lack a "best" treatment option. The role of shared decision-making (SDM) in psychiatric care seems evident, yet remains limited. Research on SDM in specialized mental health is scarce, concentrating on patients with depressive disorder or psychiatric disorders in general and less on patients with anxiety and obsessive-compulsive disorder (OCD). Furthermore, recent research concentrates on the evaluation of interventions to promote and measure SDM rather than on the feasibility of SDM in routine practice. This study investigated patients' and clinicians' perspectives on SDM to treat depression, anxiety disorders, and OCD as to better understand SDM in specialized psychiatric care and its challenges in clinical practice. METHODS Transcripts of eight focus groups with 17 outpatients and 33 clinicians were coded, and SDM-related codes were analysed using thematic analyses. RESULTS Motivators, responsibilities, and preconditions regarding SDM were defined. Patients thought SDM should be common practice given the autonomy they have over their own bodies and felt responsible for their treatments. Clinicians value SDM for obtaining patients' consent, promoting treatment adherence, and establishing a good patient-clinician relationship. Patients and clinicians thought clinicians assumed the most responsibility regarding the initiation and achievement of SDM in clinical practice. According to clinicians, preconditions were often not met, were influenced by illness severity, and formed important barriers (eg, patient's decision-making capacity, treatment availability, and clinicians' preferences), leading to paternalistic decision-making. Patients recognized these difficulties, but felt none of these preclude the implementation of SDM. Personalized information and more consultation time could facilitate SDM. CONCLUSIONS Patients and clinicians in specialized psychiatric care value SDM, but adapting it to daily practice remains challenging. Clinicians are vital to the implementation of SDM and should become versed in how to involve patients in the decision-making process, even when this is difficult.
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Affiliation(s)
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Irene van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Albert van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anne Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Weich S, Fenton SJ, Staniszewska S, Canaway A, Crepaz-Keay D, Larkin M, Madan J, Mockford C, Bhui K, Newton E, Croft C, Foye U, Cairns A, Ormerod E, Jeffreys S, Griffiths F. Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur.
Aims
To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care.
Design
The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4.
Setting
The study was conducted in 57 NHS providers of inpatient mental health care in England.
Participants
In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference.
Results
The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these.
Limitations
The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data.
Conclusions
Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data.
Future work
Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice.
Study registration
The systematic review (work package 1) is registered as PROSPERO CRD42016033556.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah-Jane Fenton
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
| | | | - Charlotte Croft
- Warwick Business School, University of Warwick, Coventry, UK
| | - Una Foye
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Aimee Cairns
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Jeffreys
- Mental Health Foundation, London, UK
- National Survivor User Network, London, UK
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Assessment of publication bias and outcome reporting bias in systematic reviews of health services and delivery research: A meta-epidemiological study. PLoS One 2020; 15:e0227580. [PMID: 31999702 PMCID: PMC6992172 DOI: 10.1371/journal.pone.0227580] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/20/2019] [Indexed: 01/04/2023] Open
Abstract
Strategies to identify and mitigate publication bias and outcome reporting bias are frequently adopted in systematic reviews of clinical interventions but it is not clear how often these are applied in systematic reviews relating to quantitative health services and delivery research (HSDR). We examined whether these biases are mentioned and/or otherwise assessed in HSDR systematic reviews, and evaluated associating factors to inform future practice. We randomly selected 200 quantitative HSDR systematic reviews published in the English language from 2007-2017 from the Health Systems Evidence database (www.healthsystemsevidence.org). We extracted data on factors that may influence whether or not authors mention and/or assess publication bias or outcome reporting bias. We found that 43% (n = 85) of the reviews mentioned publication bias and 10% (n = 19) formally assessed it. Outcome reporting bias was mentioned and assessed in 17% (n = 34) of all the systematic reviews. Insufficient number of studies, heterogeneity and lack of pre-registered protocols were the most commonly reported impediments to assessing the biases. In multivariable logistic regression models, both mentioning and formal assessment of publication bias were associated with: inclusion of a meta-analysis; being a review of intervention rather than association studies; higher journal impact factor, and; reporting the use of systematic review guidelines. Assessment of outcome reporting bias was associated with: being an intervention review; authors reporting the use of Grading of Recommendations, Assessment, Development and Evaluations (GRADE), and; inclusion of only controlled trials. Publication bias and outcome reporting bias are infrequently assessed in HSDR systematic reviews. This may reflect the inherent heterogeneity of HSDR evidence and different methodological approaches to synthesising the evidence, lack of awareness of such biases, limits of current tools and lack of pre-registered study protocols for assessing such biases. Strategies to help raise awareness of the biases, and methods to minimise their occurrence and mitigate their impacts on HSDR systematic reviews, are needed.
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Affiliation(s)
- Abimbola A. Ayorinde
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England, United Kingdom
- * E-mail:
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, England, United Kingdom
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, England, United Kingdom
| | - Fujian Song
- Department of Population Health and Primary Care, University of East Anglia, Norwich, England, United Kingdom
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Richard J. Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England, United Kingdom
| | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England, United Kingdom
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38
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Fiorillo A, Barlati S, Bellomo A, Corrivetti G, Nicolò G, Sampogna G, Stanga V, Veltro F, Maina G, Vita A. The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review. Ann Gen Psychiatry 2020; 19:43. [PMID: 32774442 PMCID: PMC7409631 DOI: 10.1186/s12991-020-00293-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
Shared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists. The present paper is a critical appraisal of recent literature on the impact of SDM in improving adherence to pharmacological treatments and in implementing the use of LAIs in the treatment of patients with schizophrenia. SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery. When considering drug treatments, clinicians must evaluate the patient's preferences, expectations and concerns towards the development of a personalized treatment strategy. Moreover, an active involvement in the decision process could reduce the patient's perception of being coerced into the use of LAIs. Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team. SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli, Largo Madonna delle Grazie, Naples, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | | | - Giuseppe Nicolò
- Department of Mental Health Colleferro, ASL Roma G, Tivoli, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli, Largo Madonna delle Grazie, Naples, Italy
| | - Valentina Stanga
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Veltro
- Mental Health Department of Campobasso, Campobasso, Italy
| | - Giuseppe Maina
- Department of Neuroscience, University of Torino, Turin, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Lovell K, Bee P, Bower P, Brooks H, Cahoon P, Callaghan P, Carter LA, Cree L, Davies L, Drake R, Fraser C, Gibbons C, Grundy A, Hinsliff-Smith K, Meade O, Roberts C, Rogers A, Rushton K, Sanders C, Shields G, Walker L. Training to enhance user and carer involvement in mental health-care planning: the EQUIP research programme including a cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Service users and carers using mental health services want more involvement in their care and the aim of this research programme was to enhance service user and carer involvement in care planning in mental health services.
Objectives
Co-develop and co-deliver a training intervention for health professionals in community mental health teams, which aimed to enhance service user and carer involvement in care planning. Develop a patient-reported outcome measure of service user involvement in care planning, design an audit tool and assess individual preferences for key aspects of care planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and carer-involved care planning. Disseminate resources to stakeholders.
Methods
A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the priorities underpinning involvement in care planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of care planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental health professionals from both the usual-care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention).
Results
The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of care planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for care are included in the care plan’. The training was delivered to 304 care co-ordinators working in community mental health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and carers, finding a failure of training to become embedded in routine care.
Limitations
Our pragmatic study was designed to improve service user and care involvement in care planning among routine community mental health services. We intervened in 18 sites with > 300 care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population.
Conclusions
We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and carer involvement in care planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results.
Future work
Research should focus on developing and evaluating new organisational initiatives in addition to training health-care professionals to address contextual barriers to service and carer involvement in care planning, and explore co-designing and delivering new ways of enhancing service users’ and carers’ capabilities to engage in care planning.
Trial registration
Current Controlled Trials ISRCTN16488358.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Patrick Cahoon
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Lesley-Anne Carter
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Claire Fraser
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Chris Gibbons
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Oonagh Meade
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Chris Roberts
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Caroline Sanders
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lauren Walker
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Yu CH, Ke C, Jovicic A, Hall S, Straus SE. Beyond pros and cons - developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development. BMC Med Inform Decis Mak 2019; 19:186. [PMID: 31533828 PMCID: PMC6749701 DOI: 10.1186/s12911-019-0898-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. METHODS This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. RESULTS Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. CONCLUSIONS A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Calvin Ke
- Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | | | - Susan Hall
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Fattori F, O'Donnell D, Rodríguez-Martín B, Kroll T. Which instruments are used to measure shared, supported and assisted healthcare decision-making between patients who have limited, impaired or fluctuating capacity, their family carers and healthcare professionals? A systematic review protocol. HRB Open Res 2019; 2:19. [DOI: 10.12688/hrbopenres.12932.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient’s values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined “Assisted” in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity. Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals. Methods: A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments. Discussion: The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals. Registration: PROSPERO CRD42018105360; registered on 10/08/2018.
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Shields M, Scully S, Sulman H, Borba C, Trinh NH, Singer S. Consumers' Suggestions for Improving the Mental Healthcare System: Options, Autonomy, and Respect. Community Ment Health J 2019; 55:916-923. [PMID: 31175515 PMCID: PMC7449583 DOI: 10.1007/s10597-019-00423-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
While the mental healthcare-consumer voice has gained in legitimacy and perceived value, policy initiatives and system improvements still lack input from consumers. This study explores consumers' suggestions for improving the mental healthcare system. Participants (N = 46) were conveniently recruited and responded to an online survey asking: "What are your suggestions for improving the mental healthcare system?" Eight themes were identified using iterative, inductive and deductive coding. Themes included treatment options, autonomy and empowerment, respect and relationships, medication management, peer support, insurance and access, funding and government support, and treatment environment. Theoretically, there is interdependence among themes where five of the themes are foundational for the three main themes (i.e. treatment options, autonomy and empowerment, respect and relationships). Findings suggest that consumers see the need for improvement in patient-centered care. While access is the focus of much mental healthcare policy discussions, the ultimate goal should be provisioning person-centered mental healthcare.
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Affiliation(s)
- Morgan Shields
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sara Scully
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Heidi Sulman
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Christina Borba
- Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Nhi-Ha Trinh
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sara Singer
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Mongan Institute Health Policy Center, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Stanford University School of Medicine and Graduate School of Business, Stanford, CA, USA
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43
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Burn E, Conneely M, Leverton M, Giacco D. Giving Patients Choices During Involuntary Admission: A New Intervention. Front Psychiatry 2019; 10:433. [PMID: 31333510 PMCID: PMC6620234 DOI: 10.3389/fpsyt.2019.00433] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background: People who receive involuntary treatment are some of the most vulnerable in psychiatric services. They are more likely to have poorer social and clinical outcomes and to be disillusioned with and disengaged from care. Research indicates that patients' experience in the first week of involuntary treatment is a critical period: a better experience of care in the first week predicts better quality of life and reduced readmission 1 year later. Patients have identified involvement in clinical decisions as key to improving their experience of care. The aim of this study was to test the feasibility and acceptability of an intervention to facilitate involvement in decision making for involuntary inpatients called OPeNS (Options, Preferences, Negotiate, and Summarise). Methods: This was a mixed method study. The OPeNS intervention was developed based on previous research carried out by a multidisciplinary team. Clinicians were trained to deliver it to involuntary inpatients. Feasibility indices (rates of participation in the intervention and time required to deliver it) were collected. Patients (N = 14) and clinicians (N = 5) provided qualitative data on their experience of the intervention in semi-structured interviews which were analysed using thematic analysis. Results: The OPeNS intervention was found to be acceptable by both patients and clinicians and feasible to conduct within the first week of involuntary treatment. Patients' and clinicians' experiences of the intervention fall into two themes: 'Enabling a different dynamic' and 'Clashing with usual practices and priorities'. Conclusion: The OPeNS intervention provides a structure that can be used by clinicians across disciplines to facilitate involving involuntary patients in decision making. Although challenges related to changing usual practices were identified, the intervention was received positively and was feasible to conduct in the first week of involuntary treatment.
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Affiliation(s)
- Erin Burn
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Maev Conneely
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Monica Leverton
- Division of Psychiatry, University College London, London, United Kingdom
| | - Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
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Finnerty M, Austin E, Chen Q, Layman D, Kealey E, Ng-Mak D, Rajagopalan K, Hoagwood K. Implementation and Use of a Client-Facing Web-Based Shared Decision-Making System (MyCHOIS-CommonGround) in Two Specialty Mental Health Clinics. Community Ment Health J 2019; 55:641-650. [PMID: 30317442 PMCID: PMC6447505 DOI: 10.1007/s10597-018-0341-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
Abstract
Electronic shared-decision making programs may provide an assistive technology to support physician-patient communication. This mixed methods study examined use of a web-based shared decision-making program (MyCHOIS-CommonGround) by individuals receiving specialty mental health services, and identified qualitative factors influencing adoption during the first 18 months of implementation in two Medicaid mental health clinics. T-tests and χ2 analyses were conducted to assess differences in patient use between sites. Approximately 80% of patients in both clinics created a MyCHOIS-CommonGround user profile, but marked differences emerged between clinics in patients completing shared decision-making reports (79% vs. 28%, χ2(1) = 109.92, p < .01) and average number of reports (7.20 vs. 3.60, t = - 3.64, p < .01). Results suggest high penetration of computer-based programs in specialty mental health services is possible, but clinic implementation factors can influence patient use including leadership commitment, peer staff funding to support the program, and implementation strategy, most notably integration of the program within routine clinical workflow.
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Affiliation(s)
- Molly Finnerty
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA.
- New York University Langone Medical Center, One Park Ave, 7th Floor, New York, NY, USA.
| | - Elizabeth Austin
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA
- Department of Surgery, University of Washington, 1107 NE 45th Street, Box 354808, Seattle, WA, USA
| | - Qingxian Chen
- New York State Office of Mental Health, 75 New Scotland Ave, CDPC Unit R, Albany, NY, USA
| | - Deborah Layman
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA
| | - Edith Kealey
- New York State Office of Mental Health, 330 5th Ave, New York, NY, 10001, USA
- NYC Department of Social Services, 150 Greenwich St., 42nd Floor, New York, NY, USA
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA, 01752, USA
| | | | - Kimberly Hoagwood
- New York University Langone Medical Center, One Park Ave, 7th Floor, New York, NY, USA
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Barr PJ, Forcino RC, Dannenberg MD, Mishra M, Turner E, Zisman-Ilani Y, Matthews J, Hinn M, Bruce M, Elwyn G. Healthcare Options for People Experiencing Depression (HOPE*D): the development and pilot testing of an encounter-based decision aid for use in primary care. BMJ Open 2019; 9:e025375. [PMID: 30962232 PMCID: PMC6500310 DOI: 10.1136/bmjopen-2018-025375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop and pilot an encounter-based decision aid (eDA) for people with depression for use in primary care. DESIGN We developed an eDA for depression through cognitive interviews and pilot tested it using a one-group pretest, post-test design in primary care. Feasibility, fidelity of eDA use and acceptability were assessed using recruitment rates and semistructured interviews with patients, medical assistants and clinicians. Treatment choice and shared decision-making (SDM) were also assessed. SETTING Interviews with adult patients and the public were conducted in a mall and library in Grafton County, New Hampshire, while clinician interviews took place by phone or at the clinician's office. Pilot testing occurred in a New Hampshire primary care practice. PARTICIPANTS Cognitive interviews were conducted with adults, ≥18 years, who could read English from the following stakeholder groups: history of depression, the public and clinicians. Patients with a Patient Health Questionnaire-9 score of ≥5 were recruited for piloting. RESULTS Three stages of cognitive interviews were conducted (n=28). Changes to eDA included moving the combination therapy information and access to treatment information, adding colour, modifying pictograms and editing the talk-therapy description. Clinician concerns about patient health literacy were not reflected in patient interviews. Of 59 patients who reviewed study information, 56 were eligible and agreed to participate in pilot testing; however, only 29 could be reached for follow-up. The eDA was widely accepted, though clinicians did not always use it as intended. We found no impact of eDA use on SDM, though patients chose a wider range of treatment options. CONCLUSIONS We demonstrated the feasibility of the use of an eDA for depression in primary care that was widely accepted. Further research is needed to improve the fidelity with which the eDA is used and to assess its impact on SDM and related health outcomes.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Manish Mishra
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Erick Turner
- Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Yaara Zisman-Ilani
- The Department of Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | | | | | - Martha Bruce
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Departments of Psychiatry and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Chakrabarti S. Treatment alliance and adherence in bipolar disorder. World J Psychiatry 2018; 8:114-124. [PMID: 30425942 PMCID: PMC6230924 DOI: 10.5498/wjp.v8.i5.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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47
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Renes JW, Regeer EJ, Hoogendoorn AW, Nolen WA, Kupka RW. A nationwide study on concordance with multimodal treatment guidelines in bipolar disorder. Int J Bipolar Disord 2018; 6:22. [PMID: 30341458 PMCID: PMC6195496 DOI: 10.1186/s40345-018-0130-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/17/2018] [Indexed: 12/03/2022] Open
Abstract
Background Most previous studies on concordance with treatment guidelines for bipolar disorder focused on pharmacotherapy. Few studies have included other treatment modalities. Aims To study concordance with the Dutch guideline of various treatment modalities in outpatient treatment settings for patients with bipolar disorder and to identity factors associated with concordance. Methods A nationwide non-interventional study using psychiatrists’ and patients’ surveys. Results 839 patients with bipolar or schizoaffective disorder bipolar type were included. Concordance with the guideline was highest for participation of a psychiatrist in the treatment (98%) and for maintenance pharmacotherapy (96%), but lower for supportive treatment (73.5%), use of an emergency plan (70.6%), psychotherapy (52.2%), group psychoeducation (47.2%), and mood monitoring (47%). Presence of a written treatment plan, a more specialized treatment setting, more years of education, and diagnosis of bipolar I disorder versus bipolar II, bipolar NOS, or schizoaffective disorder were significantly associated with better concordance. Conclusion In contrast to pharmacotherapy, psychosocial treatments are only implemented to a limited extend in everyday clinical practice in bipolar disorder. More effort is needed to implement non-pharmacological guideline recommendations for bipolar disorder.
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Affiliation(s)
- Joannes W Renes
- Altrecht Institute for Mental Health Care, Utrecht, Nieuwe Houtenseweg 12, 3524 SH, Utrecht, The Netherlands.
| | - Eline J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, Nieuwe Houtenseweg 12, 3524 SH, Utrecht, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Ralph W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, Nieuwe Houtenseweg 12, 3524 SH, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Schön UK, Grim K, Wallin L, Rosenberg D, Svedberg P. Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study. Int J Qual Stud Health Well-being 2018; 13:1421352. [PMID: 29405889 PMCID: PMC5804774 DOI: 10.1080/17482631.2017.1421352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. METHOD The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. RESULTS The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. CONCLUSION The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.
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Affiliation(s)
- Ulla-Karin Schön
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Katarina Grim
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden.,b Institution for Social Work , Karlstad University , Karlstad , Sweden
| | - Lars Wallin
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - David Rosenberg
- c Department of Social Work , Umeå University , Umeå , Sweden
| | - Petra Svedberg
- d School of Social and Health Sciences , Halmstad University , Halmstad , Sweden
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Souraya S, Hanlon C, Asher L. Involvement of people with schizophrenia in decision-making in rural Ethiopia: a qualitative study. Global Health 2018; 14:85. [PMID: 30134989 PMCID: PMC6103856 DOI: 10.1186/s12992-018-0403-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The involvement of people with psychosocial disabilities in decision-making is a fundamental component of a person-centred and recovery-oriented model of care, but there has been little investigation of this approach in low- and middle-income countries. The aim of this study was to explore the involvement of people with schizophrenia in decision-making relating to their care in rural Ethiopia. METHODS A qualitative study was conducted in rural Ethiopia as part of the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) project, involving two focus group discussions (n = 10) with community-based rehabilitation workers, and 18 in-depth interviews with people with schizophrenia, caregivers, health officers, supervisors and a community-based rehabilitation worker. Thematic analysis was used to examine major themes related to involvement in decision-making in this specific setting. RESULTS Involvement of people with schizophrenia in decision-making in this rural Ethiopian setting was limited and coercive practices were evident. People with schizophrenia tended to be consulted about their care only when they were considered clinically 'recovered'. Caregivers typically had a prominent role in decision-making, but they also acquiesced to the views of health care professionals. People with schizophrenia and caregivers were often unable to execute their desired choice due to inaccessible and unaffordable treatment. CONCLUSIONS Community-based rehabilitation, as a model of care, may give opportunities for involvement of people with schizophrenia in decision-making. In order to increase involvement of people with schizophrenia in rural Ethiopia there needs to be greater empowerment of service users, wider availability of treatment choices and a facilitating policy environment. Further studies are needed to explore concepts of person-centred care and recovery across cultural settings.
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Affiliation(s)
- Sally Souraya
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. .,Health Services and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Charlotte Hanlon
- Health Services and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Laura Asher
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Lovell K, Bee P, Brooks H, Cahoon P, Callaghan P, Carter LA, Cree L, Davies L, Drake R, Fraser C, Gibbons C, Grundy A, Hinsliff-Smith K, Meade O, Roberts C, Rogers A, Rushton K, Sanders C, Shields G, Walker L, Bower P. Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. PLoS One 2018; 13:e0201533. [PMID: 30133461 PMCID: PMC6104914 DOI: 10.1371/journal.pone.0201533] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
Background Severe mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning. Methods We cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of ‘autonomy support’. Primary and secondary outcomes were collected by self-report, six months after allocation. Findings In total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome. Conclusions An intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term.
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Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Penny Bee
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Helen Brooks
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Patrick Cahoon
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lindsey Cree
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Linda Davies
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Richard Drake
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Claire Fraser
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Chris Gibbons
- Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Oonagh Meade
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Chris Roberts
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Kelly Rushton
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Gemma Shields
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lauren Walker
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- * E-mail:
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