1
|
Arnbjerg CJ, Musoni-Rwililiza E, Rurangwa NU, Bendtsen MG, Murekatete C, Gishoma D, Carlsson J, Kallestrup P. Effectiveness of structured group psychoeducation for people with bipolar disorder in Rwanda: A randomized open-label superiority trial. J Affect Disord 2024; 356:405-413. [PMID: 38640974 DOI: 10.1016/j.jad.2024.04.071] [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: 11/20/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Psychoeducation is a cornerstone as an add-on to pharmacotherapy in standard care for individuals with bipolar disorder. However, evidence of the effectiveness of psychoeducation in low-resource settings is scarce. AIMS We aimed to assess the effectiveness of structured group psychoeducation versus waiting list on relapse prevention for individuals with bipolar disorder in Rwanda, a low-income country. METHODS This was a randomized open-label superiority trial. Participants aged 18 years or older with bipolar disorder were recruited at the two referral hospitals for mental health in Rwanda and randomly assigned 12 sessions of group psychoeducation or a waiting list. The program was tailored to the setting and co-designed with patients and clinicians. The follow-up period was 12 months, and the primary outcome mean number of psychiatric hospitalizations. RESULTS In February and March 2021, 154 participants were randomly assigned to receive group psychoeducation (n = 78) or to a waiting list (n = 76). The retention rate was high, with only three discontinuing the psychoeducation once they had received a session. Despite limited use of first-line pharmacotherapy, the psychoeducation reduced the risk of hospitalization by half during the 12-month follow-up (RR: 0.50(95 % CI 0.26-0.95)). Yet, no change in medical adherence was observed. LIMITATION Weekly assessment of clinical status was not feasible. CONCLUSION Structured group psychoeducation for bipolar disorder in a low-resource setting has a protective effect against readmission despite limited access to first-line pharmacotherapy. Further studies are needed to assess the effectiveness of the program in more decentralized settings with less highly trained staff. TRIAL REGISTRATION NCT04671225.
Collapse
Affiliation(s)
- Caroline J Arnbjerg
- Center for Global Health, Department of Public Health, Aarhus University, Denmark; College of Medicine and Health Sciences University of Rwanda, Rwanda.
| | - Emmanuel Musoni-Rwililiza
- Center for Global Health, Department of Public Health, Aarhus University, Denmark; College of Medicine and Health Sciences University of Rwanda, Rwanda; Mental Health Department, University Teaching Hospital of Kigali, Rwanda
| | | | - Maja Grønlund Bendtsen
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Denmark
| | - Chantal Murekatete
- Mental Health Department, University Teaching Hospital of Kigali, Rwanda
| | - Darius Gishoma
- College of Medicine and Health Sciences University of Rwanda, Rwanda; Mental Health Department, University Teaching Hospital of Kigali, Rwanda
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Per Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
| |
Collapse
|
2
|
An X, Zhang D, Wang Q, Shi X, Wang M, Wang Y, Ma J. The role of evidence-based practice and empathy in shared decision-making attitudes among newly graduated nurses: A cross-sectional study. J Adv Nurs 2024. [PMID: 38736281 DOI: 10.1111/jan.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/05/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
AIM Examine the levels of variables and explore drivers associated with shared decision-making attitudes among newly graduated nurses. DESIGN This was a descriptive and cross-sectional study. METHODS From August 2022 to October 2022, a cross-section of 216 newly graduated nurses from four comprehensive A-level hospitals in northern China was recruited using convenience sampling. Newly graduated nurses are generally defined as nurses with a service period of six months to one year. Data were collected using an online questionnaire support platform, including the Nursing Shared Decision-Making Attitude scale, Jefferson scale of Empathy-Health profession students and the Health Sciences Evidence-Based Practice questionnaire. All data were analysed descriptively, and correlational analysis and hierarchical regression were used to make identical connections between variables. RESULTS Newly graduated nurses supported shared decision-making. Perceptions of shared decision-making were correlated with the experiences of empathy and evidence-based practice. Additionally, perspective-taking of empathy and beliefs, and the ability to search for and apply existing scientific findings of evidence-based practice had a significant impact on more positive attitudes. CONCLUSION The survey showed that acceptance of shared decision-making was positive among newly graduated nurses. Clinical nursing managers and teachers should pay attention to cultivating the evidence-based practice and empathy of newly graduated nurses to adopt an optimistic attitude towards shared decision-making in the long term. IMPACT The survey addresses attitudes of shared decision-making among newly graduated nurses and determines whether empathy and evidence-based practice has an impact on it. The main finding is that newly graduated nurses have an optimistic outlook on the implementation of shared decision-making. This survey showed that empathy and evidence-based practice competencies are associated with shared decision-making attitudes among newly graduated nurses. The results of this survey have an impact on educational institutions and hospitals in the form of recommendations. Several training programmes on empathy and evidence-based practice can help adopt the shared decision-making attitudes of newly graduated nurses. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Xin An
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Dan Zhang
- Department of Geriatric Gastroenterology, Hebei General Hospital, Shijiazhuang, China
| | - Qiushuang Wang
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Xinhui Shi
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Mengdi Wang
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yingzhe Wang
- Department of Respiratory, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jinghua Ma
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| |
Collapse
|
3
|
Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. PATIENT EDUCATION AND COUNSELING 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [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: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
Collapse
Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Lin T, Nan X. A Scoping Review of Emerging COVID-19 Health Communication Research in Communication and Media Journals. HEALTH COMMUNICATION 2023; 38:2570-2581. [PMID: 35768394 DOI: 10.1080/10410236.2022.2091916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article reports a scoping review of emerging research on COVID-19 health communication. We reviewed and analyzed 206 articles published in 40 peer-reviewed communication journals between January 2020 to April 2021. Our review identified key study characteristics and overall themes and trends in this rapidly expanding field of research. Our review of health communication scholarship during the early stages of the COVID-19 pandemic suggests that health communication scholars have risen to the challenges and interrogated important issues in COVID-19 communication at the individual, group, organizational, and societal levels. We identified important gaps that warrant future research attention including experimental research that seeks to test the causal effects of communication, studies that evaluate communication interventions in under-served populations, research on mental health challenges imposed by the pandemic, and investigations on the promise of emerging communication technologies for supporting pandemic mitigation efforts.
Collapse
Affiliation(s)
- Tong Lin
- Department of Communication, University of Maryland
| | - Xiaoli Nan
- Department of Communication, University of Maryland
| |
Collapse
|
6
|
Bridges JFP, Goldberg JF, Fitzgerald HM, Chumki SR, Beusterien K, Will O, Citrome L. Prioritizing Treatment Goals of People Diagnosed with Bipolar I Disorder in the US: Best-Worst Scaling Results. Patient Prefer Adherence 2023; 17:2545-2555. [PMID: 37849618 PMCID: PMC10578617 DOI: 10.2147/ppa.s419143] [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: 04/28/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Bipolar I disorder (BP-I) is associated with significant disease burden, but evidence on treatment goals in people diagnosed with BP-I is scarce. This study sought to quantify treatment goals related to the pharmacological management of BP-I in adults in the US and to identify if subgroups of people with similar treatment goals exist. Patients and Methods A best-worst scaling (BWS) of treatment goals was developed based on available literature and input from experts and patients and was distributed as part of a survey between August and September 2021. Survey participants were adults with a self-reported diagnosis of BP-I who were recruited via an online panel in the US. Participants were asked to prioritize the importance of 16 treatment goals using BWS. BWS scores were computed using multinomial logistic regression, with the scores across all goals summing to 100 for each participant. Subgroups of people with similar preferences were identified using latent class analysis. Results The most important treatment goals for people diagnosed with BP-I (N=255) were "being less impulsive, angry, or irritable" (score: 9.73), or being "able to feel pleasure or happiness" (score: 9.54). Goals related to reducing the incidence of various potential adverse events of medication (scores: ≤4.51) or "reducing dependence on others" (score: 3.04) were less important. Two subgroups were identified. One subgroup (n=111) prioritized symptom-focused goals, considering "reducing frequency of mania, depression, and mixed episodes" and "being less impulsive, angry or irritable" the most important (scores: 12.46 and 11.85, respectively). The other subgroup (n=144) placed significantly more importance on social functioning-focused goals, including beginning or maintaining a relationship with a partner/significant other, and with family and/or friends (scores: 8.45 and 7.70, respectively). Conclusion People diagnosed with BP-I prioritized emotional improvements. Subgroups of people with BP-I prioritized either symptom-focused or social functioning-focused treatment goals.
Collapse
Affiliation(s)
- John F P Bridges
- Department of Biomedical Informatics, the Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sanjeda R Chumki
- Medical Affairs, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | | | | | - Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
7
|
Lamontagne-Godwin FR, Henderson C, Lafarge C, Stock R, Barley EA. The effectiveness and design of informed choice tools for people with severe mental illness: a systematic review. J Ment Health 2023; 32:260-275. [PMID: 32772607 DOI: 10.1080/09638237.2020.1803232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) report difficulty in making health-related decisions. Informed choice tools are designed to guide individuals through a decision-making process. AIMS To determine the effectiveness of these tools for people with SMI and to identify what methods and processes may contribute to effectiveness. METHOD A systematic electronic search was conducted for studies published between 1996 and January 2018. The search was updated in March 2020. Studies of any design reporting the development or evaluation of any informed choice tool for people with SMI were considered. A structured, narrative synthesis was conducted. RESULTS Ten articles describing four tools were identified. Tools were designed to assist with decision-making around bipolar treatment, smoking cessation and disclosure of mental illness in employment situations. Positive changes in decisional conflict, stage of change, knowledge and self-efficacy were reported for two tools, though insufficient data exists for definitive conclusions of effectiveness. Feedback from service users and attention to readability appeared key. CONCLUSIONS The evidence base for informed choice tools for people with SMI is limited. Such tools should be developed in stages and include the views of people with SMI at each phase; readability should be considered, and a theoretical framework should be used to facilitate process evaluation.
Collapse
Affiliation(s)
| | - Claire Henderson
- Health Service and Population Research Department, King's College London, London, UK
| | - Caroline Lafarge
- School of Human and Social Sciences, University of West London, London, UK
| | - Rosemary Stock
- School of Human and Social Sciences, University of West London, London, UK
| | | |
Collapse
|
8
|
Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137633. [PMID: 35805291 PMCID: PMC9265403 DOI: 10.3390/ijerph19137633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants’ speech was digitally audio-recorded in digital format. In order to complete the codification of the participants’ speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants’ speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state.
Collapse
|
9
|
McFarland DC, Voigt L, Alici Y. Decisional capacity determination and serious mental illness in oncology: Implications for equitable and beneficent care. Psychooncology 2021; 30:2052-2059. [PMID: 34510606 DOI: 10.1002/pon.5812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with Serious Mental Illness (SMI) have worse survival compared to cancer patients without SMI after controlling for delayed diagnosis. Decision-making capacity (DMC) may be impaired in both populations (cancer or SMI). DMC may be further impaired based on coupled vulnerability factors that challenge Shared Decision Making (SDM) for patients with cancer and SMI. METHODS Psychiatric consultations for DMC in hospitalized patients with cancer (n = 97) were consecutively evaluated across a single institution cancer center. SMI data, demographic, and cancer-related variables were obtained from the medical record. Descriptive data were contrasted in patients with and without DMC and used for logistic regression modeling. RESULTS Overall, 42% had DMC with no significant differences based on SMI (χ2 = 2.60, p = 0.11). Patients with SMI were younger, receiving anticancer treatment, and were less likely facing end of life issues. Age (OR 1.03, p = 0.05) and no recent anticancer treatments (OR 0.34, p = 0.02) were associated with decisional incapacity. At 3 months post discharge, almost two-thirds were dead with no difference based on SMI (χ2 = 0.01, p = 0.91). But End of Life (EOL) concerns were documented in 63% of non-SMI patients and only 36% of SMI patients (χ2 = 5.63, p = 0.02). Healthcare proxy (16%), four determinates of DMC (22%), and repeated psychiatric DCM assessments (35%) were documented with no differences based on SMI. CONCLUSION SDM is not equitable for cancer patients with SMI. Advanced directives and a robust effort to provide value-congruent care for patient with SMI who develop cancer may lessen this health inequity for cancer patients with SMI.
Collapse
Affiliation(s)
- Daniel C McFarland
- Department of Medicine, Northwell Health Cancer Institute, Lenox Hill Hospital, New York, USA
| | - Louis Voigt
- Department of Anesthesia and Critical Care Medicine, Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Anesthesiology, Pain, and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, USA
| | - Yesne Alici
- Department of Anesthesia and Critical Care Medicine, Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| |
Collapse
|
10
|
Crawford J, Petrie K, Harvey SB. Shared decision-making and the implementation of treatment recommendations for depression. PATIENT EDUCATION AND COUNSELING 2021; 104:2119-2121. [PMID: 33563500 DOI: 10.1016/j.pec.2021.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between shared decision-making (SDM) and the implementation of treatment recommendations amongst outpatients at a specialist Depression Clinic. METHODS A total of 110 adult outpatients in a specialist Depression Clinic in Sydney, Australia, completed an online survey examining their experiences of shared decision-making (SDM) during their psychiatrist consultation and the extent to which they later implemented Depression Clinic treatment recommendations. RESULTS The odds of implementing treatment recommendations were over four times higher in patients who reported a high level of SDM in their consultation, compared to those who reported a low level of SDM. Further, three elements of patient-rated SDM were significantly associated with an increased likelihood of implementing depression treatment recommendations. These three elements were: i) being given the opportunity to ask questions or voice concerns; ii) being asked about any problems or side effects from previous treatments; and iii) being involved in deciding their treatment plan. CONCLUSIONS SDM was significantly associated with an increased likelihood of implementing psychiatrists' treatment recommendations at a specialist Depression Clinic. PRACTICE IMPLICATIONS We recommend that clinicians be informed of the potential benefits of SDM and adopt SDM when developing treatment plans with patients living with depression.
Collapse
Affiliation(s)
- Joanna Crawford
- Black Dog Institute, University of New South Wales, Hospital Rd, Randwick, NSW, 2031, Australia.
| | - Katherine Petrie
- Black Dog Institute, University of New South Wales, Hospital Rd, Randwick, NSW, 2031, Australia; School of Psychiatry, University of New South Wales, High St, Kensington, NSW, 2052, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Hospital Rd, Randwick, NSW, 2031, Australia
| |
Collapse
|
11
|
Fisher A, Marel C, Teesson M, Mills K. Assessing patient information and decision-support needs in problematic alcohol use and co-occurring depression to inform shared decision-making interventions. Bull Menninger Clin 2021; 85:143-176. [PMID: 34032461 DOI: 10.1521/bumc.2021.85.2.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors assessed the informational and decision-support needs of patients, families, and clinicians when deciding on treatment for problematic alcohol use and depression. Patients (n = 56), family members (n = 16), and clinicians (n = 65) with experience deciding on treatment for problematic alcohol use and depression were eligible. Participants completed an online decisional needs assessment survey. Stakeholder groups identified numerous difficult patient-level treatment decisions and elevated decisional conflict. Participants preferred patient-led or shared treatment decision-making (75%-95.4%). Patients (32.6%) reported not being as involved in treatment decision-making as preferred, a higher proportion than reported by clinicians (16.4%; p = .056). More patients (19.6%) than clinicians (3.6%) reported clinician-led treatment decision-making, with little or no patient involvement (p = .022). Stakeholder preferences for future decision-support resources included online information for use outside consultations.
Collapse
Affiliation(s)
| | | | | | - Katherine Mills
- Matilda Centre for Research in Mental Health and Substance Use, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia
| |
Collapse
|
12
|
Morán-Sánchez I, Bernal-López MDLÁ, Salmerón D, Pérez-Cárceles MD. Correlates of preferring a passive role in decision-making among patients with schizophrenia or bipolar disorder. PATIENT EDUCATION AND COUNSELING 2021; 104:1125-1131. [PMID: 33268230 DOI: 10.1016/j.pec.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the factors associated with the persistence of clinician-led style in the therapeutic relationship in cases of serious mental illness, and the conditioning factors that the patients identify as determinants of their health. METHOD Assessment of preferences in the decision-making process and health-related control locus of 107 outpatients with DSM-5 diagnosis of schizophrenia or bipolar disorder. Demographic and clinical information was also obtained through review of available records and using several scales. RESULTS 64.4 % patients preferred to adopt a passive role in the therapeutic relationship. In the multivariate analysis, the preference of playing a passive role in the decision-making process was significantly associated with the elderly, being disabled, or the view that one's health depends on doctors (AUC ROC value: 0.80). CONCLUSIONS Patients with severe mental illness more frequently preferred a passive role in the decision-making process. We found several factors associated with a preference for the "expert role" model. PRACTICE IMPLICATIONS The identified factors may permit care to be tailored to the most probable expectations as regard decision-making. Since the populations concerned may be vulnerable and suffer inequalities in the provision of health services, promoting participation in the care process could help improve clinical parameters ethically.
Collapse
Affiliation(s)
- Inés Morán-Sánchez
- Health Service of Murcia, Cartagena Mental Health Centre, Cartagena, Spain.
| | | | - Diego Salmerón
- Health Sciences Department, University of Murcia, Espinardo, Spain
| | | |
Collapse
|
13
|
What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Research on the decisional capacity of schizophrenia and bipolar disorder patients mostly reflects the hospital context. Aim: To describe the views of patients, psychiatrists, and caregivers on the capacity of individuals with schizophrenia and bipolar disorder to make everyday decisions on their care related to their illness. Methods: A survey was conducted among schizophrenia and bipolar disorder patients, psychiatrists, and caregivers (June 2019 to January 2020; seven countries). A questionnaire was emailed to members of the Global Alliance of Mental Illness of Advocacy Network—Europe (GAMIAN; patients) and the European Federation of Families of People with Mental Illness (EUFAMI; caregivers) and to psychiatrists who voluntarily agreed to participate. Questions referred to patients’ involvement and capacity for healthcare decision making, and to barriers to and opportunities for autonomous decision making. Frequency, agreement, and importance were rated on Likert scales. Descriptive statistics were conducted. Results: 21 schizophrenia or bipolar disorder patients (52.3% female; mean age (years) ± SD: 50.71 ± 12.02), 11 psychiatrists (18.2% female), and 15 caregivers (86.6% female; 100% family related) participated in the survey. In total, 86% of patients felt frequently involved in decisions about everyday care and medications, and 91% of psychiatrists and 40% of caregivers perceived the same; 38% of patients felt frequently involved in decisions about the use of acute symptom medications, and 57% on care planning, and 55% and 82% of psychiatrists, and 40% and 53% of caregivers, respectively, believed the same; and 86% of patients, 91% of psychiatrists, and 47% of caregivers agreed on the capacity of schizophrenia or bipolar disorder patients to value the implications of taking medicines to prevent acute psychotic crises. Poor understanding and training are barriers, while advocacy and increasing interest in patients’ needs are opportunities for increasing autonomous decision making. Conclusions: Stakeholders concur that schizophrenia and bipolar disorder patients have the capacity to make everyday decisions around their care related to their illness, including acute symptom management. Barriers and opportunities exist to foster autonomous decisions among mental illness individuals.
Collapse
|
14
|
Fisher A, Mills K, Teesson M, Marel C. Shared decision‐making among people with problematic alcohol/other drug use and co‐occurring mental health conditions: A systematic review. Drug Alcohol Rev 2020; 40:307-324. [DOI: 10.1111/dar.13149] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/15/2020] [Accepted: 07/20/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Alana Fisher
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health The University of Sydney Sydney Australia
- The School of Psychology The University of Sydney Sydney Australia
| | - Katherine Mills
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health The University of Sydney Sydney Australia
| |
Collapse
|
15
|
When does shared decision making is adopted in psychiatric clinical practice? Results from a European multicentric study. Eur Arch Psychiatry Clin Neurosci 2020; 270:645-653. [PMID: 31175448 DOI: 10.1007/s00406-019-01031-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
Abstract
To identify factors associated with the use of shared decision making in routine mental health care in a large multicenter European study. Data have been collected within the study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR), which is a naturalistic, longitudinal, observational study carried out in six European countries. Patients with a severe mental illness attending outpatient units and their treating clinicians have been recruited. Clinicians' Clinical Decision Making (CDM) styles have been explored through the Clinical Decision Making Style Scale. Patients' clinical and social outcomes have been assessed through validated assessment instruments. The sample consisted of 588 patients and 213 professionals. Professionals were mainly psychiatrists (35.7%), nurses (21.6%), support workers, social workers or occupational therapists (24.9%), psychologists (9.9%) or trainees in psychiatry (4.7%). In the majority of cases, clinicians adopted a shared CDM style. Shared CDM was more frequently adopted with patients with psychotic disorders, with a better quality of life and social functioning. At multivariate analyses, the likelihood of adopting shared decision making increased in patients with higher levels of interpersonal relationships' skills (p < 0.05) and global functioning (p < 0.01). On the contrary, being a trainee in psychiatry reduced the likelihood of adopting shared CDM (p < 0.008). Shared decision making has been adopted mainly when patients have a better functioning and less severe clinical symptomatology and by less trained clinicians, differently from national and international recommendations. More efforts should be made to implement interventions to promote shared CDM, with a specific focus for trainees in psychiatry.
Collapse
|
16
|
Coronado-Vázquez V, Canet-Fajas C, Delgado-Marroquín MT, Magallón-Botaya R, Romero-Martín M, Gómez-Salgado J. Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review. Medicine (Baltimore) 2020; 99:e21389. [PMID: 32769870 PMCID: PMC7593011 DOI: 10.1097/md.0000000000021389] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) is a process within the physician-patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients' and health professionals' satisfaction with the intervention. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool. RESULTS Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. CONCLUSIONS DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.
Collapse
Affiliation(s)
- Valle Coronado-Vázquez
- Aragonese Primary Care Research Group B21-17R. Health Research Institute of Aragon (IIS). Department of Nursing. Faculty of Health Sciences. Catholic University of Ávila. Castilla La Mancha Health Service, Toledo
| | | | - Maria Teresa Delgado-Marroquín
- Bioethics Research Group. Health Research Institute of Aragon (IIS). Faculty of Medicine, University of Zaragoza. Delicias Norte Primary Care Health Center, Zaragoza
| | - Rosa Magallón-Botaya
- Aragonese Primary Care Research Group B21-17R. Health Research Institute of Aragon (IIS). Department of Medicine, University of Zaragoza. Arrabal Primary Care Health Center, Zaragoza
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program, Espiritu Santo University, Guayaquil, Ecuador
| |
Collapse
|
17
|
Calcedo-Barba A, Fructuoso A, Martinez-Raga J, Paz S, Sánchez de Carmona M, Vicens E. A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare. BMC Psychiatry 2020; 20:339. [PMID: 32605645 PMCID: PMC7324958 DOI: 10.1186/s12888-020-02756-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/23/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions. METHODS Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews. RESULTS Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains. CONCLUSIONS Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.
Collapse
Affiliation(s)
- A. Calcedo-Barba
- grid.4795.f0000 0001 2157 7667Department of Psychiatry, Hospital Gregorio Marañón; Medical School, Universidad Complutense de Madrid, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - A. Fructuoso
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Service and Geneva Penal Medicine Division, Geneva University Hospitals, Puplinge, Switzerland
| | - J. Martinez-Raga
- grid.5338.d0000 0001 2173 938XPsychiatry Service, University Hospital Doctor Peset, University of Valencia, Valencia, Spain
| | - S. Paz
- SmartWriting4U, Valencia, Spain
| | - M. Sánchez de Carmona
- grid.412847.c0000 0001 0942 7762Medical School, Universidad Anáhuac, Mexico City, Mexico
| | - E. Vicens
- grid.466982.70000 0004 1771 0789Department of Psychiatry, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| |
Collapse
|
18
|
Chakrabarti S. Treatment Attitudes and Adherence Among Patients with Bipolar Disorder: A Systematic Review of Quantitative and Qualitative Studies. Harv Rev Psychiatry 2020; 27:290-302. [PMID: 31385812 DOI: 10.1097/hrp.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systematic reviews about treatment attitudes of patients influencing adherence in bipolar disorder (BD) are rare. METHODS A systematic review was conducted according to the PRISMA guidelines and principles of thematic synthesis. Selectively identified quantitative and qualitative studies were used to examine the attitude-adherence relationship in BD, the types and correlates of treatment attitudes, and the impact of psychosocial interventions on attitudes. RESULTS The final list of 163 articles included 114 observational reports (incorporating 21 psychosocial intervention trials), 45 qualitative/descriptive studies, and 4 patient surveys. A positive association between treatment attitudes and adherence was found in most quantitative and qualitative studies, though the strength of the relationship was unclear. Thematic analysis of qualitative studies suggested that patient attitudes influencing adherence were based on perceived advantages and disadvantages of treatment. The principal correlates of patients' attitudes were family attitudes, the clinician-patient alliance, social support, and patients' knowledge of BD. Though negative attitudes such as denial, concerns about adverse treatment consequences, and stigmatizing effects of treatment were common, many patients believed treatment to be beneficial and necessary. The limited data on the effect of psychosocial interventions indicated that treatments selectively targeting attitudes enhanced adherence. LIMITATIONS The studies were heterogeneous in design; the quality was uneven (fair to poor); and the risk of bias moderate to high. CONCLUSIONS Despite these flaws, awareness of the existing evidence on the attitude-adherence association and other aspects of treatment attitudes in BD can help in efforts to address nonadherence in BD.
Collapse
Affiliation(s)
- Subho Chakrabarti
- From the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh (India)
| |
Collapse
|
19
|
Tse S, Ng RM, Yuen W. Education about Medication for People with Bipolar Disorder Comes from Many Sources. Psychiatry 2020; 83:195-196. [PMID: 32059114 DOI: 10.1080/00332747.2020.1716441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
20
|
Stip E, Abdel-Baki A, Roy MA, Bloom D, Grignon S. [Long-acting antipsychotics: The QAAPAPLE algorithm review]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:697-707. [PMID: 31088133 PMCID: PMC6783667 DOI: 10.1177/0706743719847193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Eight years ago, a committee of experts from 4 Quebec university psychiatry departments has provided the QAAPAPLE algorithm in order to guide clinicians in their use of long-acting antipsychotics (LAAP) for patients with psychotic disorders. OBJECTIVE Update the QAAPAPLE algorithm. METHODS Using a qualitative and selective literature review, the experts have focused on several aspects related to the use of LAAP and the relevance of modifying the algorithm: 1) new data on LAAP (including polypharmacy and co-prescription with clozapine, dose frequency/interval); 2) perception and attitude regarding algorithms and evidence; 3) difficulties in implementing algorithms; 4) polypharmacy involving LAAP and co-prescriptions with clozapine; 5) partner patients perspective on the algorithm. RESULTS Thirteen meta-analysis were published and completed observational studies (including those on national registries), confirming the LAAP benefits. Literature adds specifications about using some drug associations as well as dose frequency and interval. Therefore, scientific advances have been considered to modify the algorithm. CONCLUSION Interacting with Quebec psychiatrists, we have examined changes in prescription and literature to better understand the use of algorithm. The committee has updated the QAAPAPLE algorithm to guide clinicians in using LAAP along the path of patients with psychosis as early as the first episode and through different clinical settings (including treatment resistance) in order to have a more flexible and user-friendly treatment.
Collapse
Affiliation(s)
- Emmanuel Stip
- Professeur titulaire de psychiatrie, département de psychiatrie de l'Université de Montréal, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Professeur titulaire de clinique, Université de Montréal, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.,chercheure Centre de recherche CHUM, Montreal, Québec, Canada
| | - Marc-André Roy
- Professeur agrégé, département de Psychiatrie et Neurosciences, Université Laval; chercheur, centre de recherche CERVO, directeur médical, Clinique Notre-Dame des Victoires, Québec, Québec, Canada
| | - David Bloom
- Chef médical, Programme de déficience intellectuelle avec comorbidité psychiatrique, Chef médical, Programme des troubles psychotiques, Professeur adjoint, département de psychiatrie, Université McGill, Montréal, Québec, Canada
| | - Sylvain Grignon
- Professeur titulaire, Département de Psychiatrie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
21
|
What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components. Epidemiol Psychiatr Sci 2019; 29:e48. [PMID: 31412975 PMCID: PMC8061300 DOI: 10.1017/s2045796019000428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
Collapse
|
22
|
Belzeaux R, Sanguinetti C, Murru A, Verdolini N, Pacchiarotti I, Hidalgo-Mazzei D, Cohen L, Anmella G, Barbuti M, Vieta E, Llorca PM, Samalin L. Pharmacotherapy for the peripartum management of bipolar disorder. Expert Opin Pharmacother 2019; 20:1731-1741. [PMID: 31159601 DOI: 10.1080/14656566.2019.1626826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The peripartum period in bipolar disorder (BD) patients is associated with high risk of relapse. Relapse during this period may affect fetal and child development. The consequences of psychotropic medication during pregnancy are also a major concern. The extent to which mood stabilizers may potentially affect the embryogenesis or the child development varies from high (e.g. valproate) to less clear and more debated (e.g. lithium). Areas covered: This review describes the current state of evidence with respect to the impact of recommended pharmacological interventions for BD during the peripartum period. It compares recent international treatment guidelines for the management of BD during the peripartum period. Last, this review presents a summary of key recommendations for BD women of childbearing age, for BD women during pregnancy and postpartum period from the international guidelines. Expert opinion: Management of the pharmacological treatment for BD patients during the perinatal period is challenging. Although treatment guidelines may be of significant help, high heterogeneity exists across them. Shared decision-making represents a useful patient-centered approach during the perinatal period. Large cohort studies are needed to better identify risk associated to treatment discontinuation or treatment exposure.
Collapse
Affiliation(s)
- Raoul Belzeaux
- APHM, Department of psychiatry and INT-UMR7289, CNRS Aix Marseille University , Marseille , France.,Fondation FondaMental , Créteil , France
| | - Catherine Sanguinetti
- APHM, Department of psychiatry and INT-UMR7289, CNRS Aix Marseille University , Marseille , France
| | - Andrea Murru
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Norma Verdolini
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain.,FIDMAG Germanes Hospitalaries Research Foundation , Barcelona , Catalonia , Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia , Perugia , Italy
| | - Isabella Pacchiarotti
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Lola Cohen
- APHM, Department of psychiatry and INT-UMR7289, CNRS Aix Marseille University , Marseille , France
| | - Gerard Anmella
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Margherita Barbuti
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa , Pisa , Italy
| | - Eduard Vieta
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Pierre-Michel Llorca
- Fondation FondaMental , Créteil , France.,Department of Psychiatry, CHU Clermont-Ferrand and University of Clermont Auvergne, EA 7280 , Clermont-Ferrand , France
| | - Ludovic Samalin
- Fondation FondaMental , Créteil , France.,Department of Psychiatry, CHU Clermont-Ferrand and University of Clermont Auvergne, EA 7280 , Clermont-Ferrand , France
| |
Collapse
|
23
|
Berry N, Lobban F, Bucci S. A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems. BMC Psychiatry 2019; 19:35. [PMID: 30665384 PMCID: PMC6341527 DOI: 10.1186/s12888-018-1979-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The development of digital health interventions (DHIs) for severe mental health problems is fast-paced. Researchers are beginning to consult service users to inform DHIs; however, much of this involvement has been limited to feedback on specific interventions post-DHI development. This study had two aims: 1. explore service user views towards DHIs for severe mental health problems; and 2. make recommendations for specific content within DHIs based on service user needs and suggestions. METHODS Qualitative interviews with eighteen people with severe mental health problems focussed on two domains: 1) views about DHIs for severe mental health problems; and 2) ideas for future DHI content and design features. Data were analysed thematically. RESULTS Participants responses were captured in five key themes: 1) DHIs could be empowering tools that instigate reflection and change; 2) society is already divided; DHIs will further increase this divide; 3) considerations must be made about who has access to DHI data and how this data may be used; 4) DHIs should not be delivered without other support options; and 5) DHIs should provide a positive, fun, practical and interactive method for self-management. CONCLUSIONS Participants found DHIs acceptable due to the empowering nature of self-management and ability to take ownership of their own healthcare needs. However, concerns included the potential for digital exclusion, privacy and confidentiality and fears about DHIs being used to replace other mental health services. Service users want tools to help them self-manage their mental health, but also provide positive and recovery-focussed content that can be used in conjunction with other support options.
Collapse
Affiliation(s)
- Natalie Berry
- Division of Psychology and Mental Health, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, Faculty of Biology University of Manchester, Brunswick Street, Manchester, UK.
| | - Fiona Lobban
- 0000 0000 8190 6402grid.9835.7Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sandra Bucci
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, Faculty of Biology University of Manchester, Brunswick Street, Manchester, UK ,0000 0004 0581 2008grid.451052.7Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
24
|
Fisher A, Sharpe L, Costa D, Anderson J, Manicavasagar V, Juraskova I. Phase II Randomised Controlled Trial of a patient decision-aid website to improve treatment decision-making for young adults with bipolar II disorder: A feasibility study protocol. Contemp Clin Trials Commun 2018; 12:137-144. [PMID: 30456328 PMCID: PMC6234496 DOI: 10.1016/j.conctc.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/01/2018] [Accepted: 11/07/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/AIMS This paper describes the protocol for a feasibility study for a parallel Phase II randomised control trial (RCT) aiming to evaluate a novel decision-aid website (e-DA) to support young adults with bipolar II disorder (BPII), and their families. MATERIAL AND METHODS The e-DA was developed according to the International Patient Decision-Aid Standards (IPDAS). Participants will be 40 young adults (18-30 years) referred to a specialist outpatient clinical facility, who have a confirmed clinical diagnosis of BPII. Participants will be randomised (1:1) to receive access to the clinic's online factsheets/website with (Intervention) or without (Control) the e-DA. A series of validated and purpose-designed questionnaires will be administered at baseline (T0), immediately post-decision (T1), and 3 months post-decision (T2). Questionnaires assess key decision-making constructs related to decision-making quality, including: decisional conflict, subjective and objective treatment knowledge, values-based informed choice, concordance between preferred/actual decision-making involvement, preparation for decision-making, and decisional regret. Self-report symptom severity and anxiety will ascertain the safety of e-DA use. The focus of analyses will be to assess effect sizes, in order to guide a future RCT. DISCUSSION This feasibility study will evaluate a world first, evidence-based online decision-support resource, a DA website, for young adults with BPII and their families who are deciding on treatment options for relapse prevention. Findings will determine the e-DA's feasibility in RCT procedures (i.e., outpatient clinical setting) and provide estimates of effect sizes on outcomes related to improving treatment decision-making and patient outcomes in a sample of potential end-users, compared to usual care. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12617000840381.
Collapse
Affiliation(s)
- Alana Fisher
- School of Psychology, Brennan MacCallum Building (A18), The University of Sydney, NSW, 2006, Australia
- Centre for Medical and Evidence-based Decision-making (CeMPED), Level 6, Chris O'Brien Lifehouse (C39Z), The University of Sydney, NSW, 2006, Australia
| | - Louise Sharpe
- School of Psychology, Brennan MacCallum Building (A18), The University of Sydney, NSW, 2006, Australia
| | - Daniel Costa
- Sydney Medical School, Edward Ford Building (A27), The University of Sydney, NSW, 2006, Australia
| | - Josephine Anderson
- The Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Vijaya Manicavasagar
- The Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Ilona Juraskova
- School of Psychology, Brennan MacCallum Building (A18), The University of Sydney, NSW, 2006, Australia
- Centre for Medical and Evidence-based Decision-making (CeMPED), Level 6, Chris O'Brien Lifehouse (C39Z), The University of Sydney, NSW, 2006, Australia
| |
Collapse
|
25
|
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.
Collapse
Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| |
Collapse
|
26
|
Verwijmeren D, Grootens KP. Shared decision making in pharmacotherapy decisions, perceived by patients with bipolar disorder. Int J Bipolar Disord 2018; 6:21. [PMID: 30284089 PMCID: PMC6170516 DOI: 10.1186/s40345-018-0129-5] [Citation(s) in RCA: 8] [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: 05/26/2018] [Accepted: 08/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background Shared decision making has been promoted as standard care, but there has been debate on the possible types. On the one hand, there is a more ‘instrumental’/objective approach focused on the exchange of information, but an ‘interpersonal’/subjective patient involvement has been suggested as well. In this study we aim to investigate this further by assessing both actual and perceived patient involvement in medical decisions. Methods Eighty-one consultations between patients with bipolar disorder and their clinicians were observed and scored using the OPTION scale. Afterwards, the patients’ experienced involvement was explored with the SDM-Q-9. Furthermore, several patient characteristics were gathered. Correlations between the scores were examined. Results The clinicians scored on average 34.6 points on the OPTION scale. In contrast, patients scored on average 77.5 points on the SDM-Q-9, suggesting that patients felt more involved in the consultation than was observable. Conclusion Our patients with bipolar disorder feel involved in pharmacotherapy decisions, but this is not scored in objective observations. Our data suggest that there are implicit, interpersonal aspects of patient involvement in shared decision making, a concept that deserves further attention and conceptualisation.
Collapse
Affiliation(s)
- Doris Verwijmeren
- Reinier van Arkel Mental Health Institute, Postbus 70058, 5201 DZ, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Reinier van Arkel Mental Health Institute, Postbus 70058, 5201 DZ, 's-Hertogenbosch, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
27
|
van den Heuvel SCGH, Meije D, Regeer EJ, Sinnema H, Riemersma RF, Kupka RW. The user experiences and clinical outcomes of an online personal health record to support self-management of bipolar disorder: A pretest-posttest pilot study. J Affect Disord 2018; 238:261-268. [PMID: 29894931 DOI: 10.1016/j.jad.2018.05.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/21/2018] [Accepted: 05/28/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Self-management comprises knowledge, behavior, activities and resources providing people with bipolar disorder (BD) control over fluctuating mood and activity-patterns. The 'Self-management and Dialogue in Bipolar Disorder' project entailed the tailoring of an online personal health record (PHR) originally designed for the chronically ill to monitor condition and share information with their clinician to people with BD (PHR-BD). The aim of this study was to evaluate the feasibility, utility and user-experiences of participants with BD, relatives, and healthcare professionals who worked with the PHR-BD. METHODS Post-test online closed- and open ended questionnaires were used to collect information on utility, and user-experiences with PHR-BD. A pre-posttest design to evaluate clinical effects on quality of life, empowerment, symptom reduction, changes in mood and activity, and illness burden and severity at baseline and at 12-months follow-up. RESULTS Sixty-six participants with BD logged in at baseline. At study endpoint thirty-nine participants with BD, eleven professionals and one family caregiver filled out the evaluations. No significant differences in the clinical outcomes from baseline were found. Qualitative evaluations showed a frequent utility of the mood chart modules, improved communication between clinician and participant with BD and, increased insight in influencing factors of mood fluctuations. LIMITATIONS Small convenience sample, no controls. CONCLUSIONS The option to alternate the interface from a prospective to a retrospective mood chart , and integration with the personal crisis plan was considered to be of added value in self-managing BD. The findings of this study will guide the future implementation of the PHR-BD.
Collapse
Affiliation(s)
- Silvio C G H van den Heuvel
- Saxion University of Applied Sciences, Expertise Center for Health, Social Care and Technology, Deventer, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Dimence Group, Center for Mental Health Care, Deventer, The Netherlands; Catholic University of Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium.
| | - Daniëlle Meije
- Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands.
| | - Eline J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.
| | - Henny Sinnema
- Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands.
| | - Rixt F Riemersma
- University Groningen, Department of Psychiatry, University Medical Center, Groningen, The Netherlands; Lentis Institute for Mental Health Care, Groningen, The Netherlands.
| | - Ralph W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands; Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; GGZ InGeest Institute for Mental Health Care, Amsterdam, The Netherlands.
| |
Collapse
|
28
|
Fisher A, Sharpe L, Anderson J, Manicavasagar V, Juraskova I. Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse. PLoS One 2018; 13:e0200490. [PMID: 29990368 PMCID: PMC6039033 DOI: 10.1371/journal.pone.0200490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Treatment decisions in bipolar II disorder (BPII) are finely-balanced and sensitive to patient preferences. This pilot study evaluated a decision-aid booklet (DA) for patients with BPII (and their family) to obtain evidence on its acceptability, feasibility, safety, and usefulness in potential end-users. Methods The DA booklet was developed according to International Patient Decision-Aid Standards. Thirty-one patients diagnosed with BPII and their families (n = 11), who were currently making or had previously made treatment decisions, participated. Participants read the DA and completed validated and purpose-designed questionnaires. A follow-up semi-structured telephone interview elicited more in-depth DA feedback (n = 40). Results Patients and family endorsed the DA booklet as: easy-to-use (100% agree), useful in treatment decision-making (100%), presenting balanced (patients = 96.8%, family = 100%), up-to-date (93.5%, 100%) and trustworthy information (93.5%, 100%) that did not provoke anxiety (93.5%, 90.9%). All participants stated that they would recommend the DA to others. Following DA use, all except one participant (97.6%) demonstrated adequate treatment knowledge (> 50% score). Patients reported low decisional conflict (M = 18.90/100) following DA use and felt well-prepared to make treatment decisions (M = 4.28/5). Most patients (90.3%) indicated uptake of treatments consistent with the best available clinical evidence. Additionally, a large proportion of patients made an informed choice about medication (65.5%) with adjunctive psychological treatment (50.0%), based on adequate knowledge and their treatment values. Interview findings further supported the DA’s acceptability among participants. Discussion Pilot findings indicate that patients with BPII and their family consider this DA booklet highly acceptable and useful in making evidence-based treatment decisions that align with their treatment preferences.
Collapse
Affiliation(s)
- Alana Fisher
- The School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- The Centre for Medical and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Louise Sharpe
- The School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Josephine Anderson
- The Black Dog Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
- The School of Psychiatry, The University of New South Wales, Sydney, New South Wales, Australia
| | - Vijaya Manicavasagar
- The Black Dog Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
- The School of Psychiatry, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- The School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- The Centre for Medical and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
29
|
Deb S, Miller NA. Relationships Among Race/Ethnicity, Gender, and Mental Health Status in Patient–Provider Interactions. JOURNAL OF DISABILITY POLICY STUDIES 2018. [DOI: 10.1177/1044207318772064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient–provider interactions are associated with improved health outcomes and are of particular importance to individuals with mental health disabilities. We examine the relation between having a severe mental health–related disability (SMD) and patient–provider interactions and whether this is moderated by patient race/ethnicity and gender. We pooled Medical Expenditure Panel Survey data over multiple years and used multivariate techniques to examine the relation between having a SMD, race/ethnicity and gender and four measures of patient/provider interactions (e.g., being treated with respect). Adults with SMD had significantly higher relative risks (RRs) of reporting poorer interactions across measures. Although some effects of race/ethnicity and gender were observed, they did not moderate SMD. Individuals with Medicaid coverage or no health insurance had higher RRs of poorer interactions, while individuals with a person as a usual source of care had lower RRs. Incorporating these process measures of care into national quality initiatives may foster improved interactions. Continued policy support of models of care such as medical homes may enhance interactions as well.
Collapse
Affiliation(s)
- Shreyasi Deb
- American Academy of Orthopaedic Surgeons, Washington, DC, USA
| | | |
Collapse
|
30
|
Samalin L, Honciuc M, Boyer L, de Chazeron I, Blanc O, Abbar M, Llorca PM. Efficacy of shared decision-making on treatment adherence of patients with bipolar disorder: a cluster randomized trial (ShareD-BD). BMC Psychiatry 2018; 18:103. [PMID: 29653535 PMCID: PMC5899333 DOI: 10.1186/s12888-018-1686-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. SDM has raised great interest in mental healthcare over the last decade, as it is considered a fundamental part of patient-centered care. However, there is no research evaluating the efficacy of SDM compared to usual care (CAU), as it relates to quality of care and more specifically treatment adherence, in bipolar disorder (BD). METHODS/DESIGN This is a 12-month multi-centre, cluster-randomized controlled trial comparing the efficacy of SDM to CAU. Adult BD patients (n = 300) will be eligible after stabilization for at least 4 weeks following an acute mood episode. The intervention will consist of applying the standardized SDM process as developed by the Ottawa Hospital Research Institute in order to choose the maintenance treatment of BD. A multidisciplinary team developed a decision aid "choose my long-term treatment with my doctor" for BD patients to clarify possible therapeutic options. Primary outcome will assess the patient's level of adherence (based on hetero-evaluation) of ongoing treatment at 12 months. Secondary outcomes will assess the difference between the 2 groups of patients in terms of adherence to maintenance drug therapy based on other measures (self-assessment scale and plasma levels of mood stabilizers). Additionally, other dimensions will be assessed: decisional conflict, satisfaction with care and involvement in decision making, beliefs about treatment, therapeutic relationship, knowledge about information for medical decision and clinical outcomes (depression, mania, functioning and quality of life). The primary endpoint will be analysed without adjustment by comparison of adherence scores between the two groups using Student t-tests or Mann-Whitney tests according to the variable distribution. A set of secondary analyses will be adjusted for covariates of clinical interest using generalized linear mixed regression models. DISCUSSION This will be the first study evaluating the effect of an SDM intervention on patient adherence in BD. This is also an innovative protocol because it proposes the development of an evidence-based tool that should help patients and clinicians to initiate discussions regarding the use of BD treatment. TRIAL REGISTRATION The study has been registered with ClinicalTrials.gov as NCT03245593 .
Collapse
Affiliation(s)
- L. Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life research Unit, EA 3279 Marseille, France
| | - M. Honciuc
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | - L. Boyer
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life research Unit, EA 3279 Marseille, France
| | - I. de Chazeron
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | - O. Blanc
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | | | - P. M. Llorca
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| |
Collapse
|
31
|
Samalin L, Genty JB, Boyer L, Lopez-Castroman J, Abbar M, Llorca PM. Shared Decision-Making: a Systematic Review Focusing on Mood Disorders. Curr Psychiatry Rep 2018; 20:23. [PMID: 29589129 DOI: 10.1007/s11920-018-0892-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This study aims to provide a review of the randomized controlled studies evaluating the effects of shared decision-making (SDM) intervention in comparison to care as usual in patients with mood disorders. RECENT FINDINGS Of the 14 randomized controlled studies identified, only three 6-month studies evaluated the interest of SDM interventions using decision aids in depressed patients. All of them showed that the intervention effectively improved patient satisfaction and engagement in the decision-making process. Only one study in patients with bipolar disorder (BD) showed improvement of depressive symptoms, functioning, and quality of life. Other included studies were collaborative care interventions using a SDM approach in patients with depression in specific populations depending on age, gender, income, and physical comorbidities. All of them showed significant improvement in depression outcomes or medication adherence. SDM interventions using decision aids and collaborative care showed evidence of improvements in the management of depression. Stronger evidence of SDM interest in BD is needed.
Collapse
Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, EA7280, Clermont-Ferrand, France. .,Service de Psychiatrie B, Centre Hospitalier Universitaire, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Jean-Baptiste Genty
- CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, EA7280, Clermont-Ferrand, France
| | - Laurent Boyer
- Public Health, Chronic Diseases and Quality of Life Research Unit, Aix-Marseille University, EA3279, Marseille, France
| | - Jorge Lopez-Castroman
- CHU Nimes, Nimes, France.,INSERM Unit 1061, University of Montpellier, Montpellier, France
| | | | - Pierre-Michel Llorca
- CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, EA7280, Clermont-Ferrand, France
| |
Collapse
|
32
|
A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder. Community Ment Health J 2017; 53:958-971. [PMID: 28102459 DOI: 10.1007/s10597-016-0077-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023]
Abstract
This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.
Collapse
|
33
|
Bobo WV. The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update. Mayo Clin Proc 2017; 92:1532-1551. [PMID: 28888714 DOI: 10.1016/j.mayocp.2017.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 12/21/2022]
Abstract
Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness. Effective treatments are available for each illness phase, but mood episode relapses and incomplete responses to treatment are common, especially for the depressive phase. Mood symptoms, psychosocial functioning, and suicide risk must, therefore, be continually reevaluated, and, when necessary, the plan of care must be adjusted during long-term treatment. Many patients will require additional treatment of comorbid psychiatric and substance use disorders and management of a variety of commonly co-occurring chronic general medical conditions.
Collapse
Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| |
Collapse
|
34
|
Molokwu JC, Penaranda E, Shokar N. Decision-Making Preferences Among Older Hispanics Participating in a Colorectal Cancer (CRC) Screening Program. J Community Health 2017; 42:1027-1034. [DOI: 10.1007/s10900-017-0352-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Fisher A, Manicavasagar V, Sharpe L, Laidsaar-Powell R, Juraskova I. A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder. J Ment Health 2017; 27:66-79. [PMID: 28084845 DOI: 10.1080/09638237.2016.1276533] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. AIM To explore patient and family perspectives of treatment decision-making in BPII. METHOD Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. RESULTS Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. CONCLUSIONS This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. DECLARATION OF INTEREST This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.
Collapse
Affiliation(s)
- Alana Fisher
- a School of Psychology.,b Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney , New South Wales , Australia
| | - Vijaya Manicavasagar
- c School of Psychiatry , and.,d Black Dog Institute, University of New South Wales , New South Wales , Australia
| | | | - Rebekah Laidsaar-Powell
- a School of Psychology.,b Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney , New South Wales , Australia
| | - Ilona Juraskova
- a School of Psychology.,b Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney , New South Wales , Australia
| |
Collapse
|
36
|
Phelps J. A powerful non-pharmacologic treatment for mania - virtually. Bipolar Disord 2016; 18:379-82. [PMID: 27218661 DOI: 10.1111/bdi.12393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
|