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Treichler EBH, McBride LE, Gomez E, Jain J, Seaton S, Yu KE, Oakes D, Perivoliotis D, Girard V, Reznik S, Salyers MP, Thomas ML, Spaulding WD, Granholm EL, Rabin BA, Light GA. Enhancing patient-clinician collaboration during treatment decision-making: study protocol for a community-engaged, mixed method hybrid type 1 trial of collaborative decision skills training (CDST) for veterans with psychosis. Trials 2024; 25:363. [PMID: 38840160 PMCID: PMC11155075 DOI: 10.1186/s13063-024-08127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Patient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST's feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST's effectiveness in comparison with an active control and further evaluate implementation feasibility. METHODS The planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation. DISCUSSION If CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally. TRIAL REGISTRATION ClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.
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Affiliation(s)
- Emily B H Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA.
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA.
| | - Lauren E McBride
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
| | - Elissa Gomez
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joanna Jain
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Sydney Seaton
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Kasey E Yu
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - David Oakes
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
- VA San Diego Psychology Service, San Diego, CA, USA
| | | | - Samantha Reznik
- University of Texas at Austin, Texas Institute for Excellence in Mental Health, Austin, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - Eric L Granholm
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
- VA San Diego Psychology Service, San Diego, CA, USA
| | - Borsika A Rabin
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Center of Excellence in Stress and Mental Health, San Diego VA, La Jolla, CA, USA
| | - Gregory A Light
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
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Treichler EBH, Reznik SJ, Oakes D, Girard V, Zisman-Ilani Y. Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations. BJPsych Open 2023; 9:e154. [PMID: 37578050 PMCID: PMC10486237 DOI: 10.1192/bjo.2023.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.
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Affiliation(s)
- Emily B. H. Treichler
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA; and Department of Psychiatry, University of California, San Diego, California, USA
| | - Samantha J. Reznik
- VA San Diego Psychosocial Rehabilitation and Recovery Center, San Diego, California, USA; and Texas Institute for Excellence in Mental Health, University of Texas at Austin, Austin, Texas, USA
| | - David Oakes
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA
| | - Vanessa Girard
- VA San Diego Psychosocial Rehabilitation and Recovery Center, VA San Diego, San Diego, California, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA; and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
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Treichler EBH, Mercado R, Oakes D, Perivoliotis D, Gallegos-Rodriguez Y, Sosa E, Cisneros E, Spaulding WD, Granholm E, Light GA, Rabin B. Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers. BMC Health Serv Res 2022; 22:1543. [PMID: 36528579 PMCID: PMC9759039 DOI: 10.1186/s12913-022-08833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. METHODS A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes-no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). RESULTS Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. CONCLUSIONS A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations.
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Affiliation(s)
- Emily B. H. Treichler
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Robert Mercado
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - David Oakes
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Dimitri Perivoliotis
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Yuliana Gallegos-Rodriguez
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Elijah Sosa
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Erin Cisneros
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - William D. Spaulding
- grid.24434.350000 0004 1937 0060Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588 USA
| | - Eric Granholm
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Gregory A. Light
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Borsika Rabin
- grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.266100.30000 0001 2107 4242Clinical and Translational Research Center Dissemination and Implementation Science Center, UC San Diego Altman, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
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Luciano M, Fiorillo A, Brandi C, Di Vincenzo M, Egerhazi A, Hiltensperger R, Kawhol W, Kovacs AI, Rossler W, Slade M, Pushner B, Sampogna G. Impact of clinical decision-making participation and satisfaction on outcomes in mental health practice: results from the CEDAR European longitudinal study. Int Rev Psychiatry 2022; 34:848-860. [PMID: 36786107 DOI: 10.1080/09540261.2022.2085507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present study aimed to assess: (1) whether a more active involvement of patients is associated with an improvement of clinical symptoms, global functioning, and quality-of-life; and (2) how patients' satisfaction with clinical decisions can lead to better outcome after 1 year. Data were collected as part of the study 'Clinical decision-making and outcome in routine care for people with severe mental illness (CEDAR)', a longitudinal observational study, funded by the European Commission and carried out in six European countries. Patients' inclusion criteria were: (a) aged between 18 and 60 years; (b) diagnosis of a severe mental illness of any kind according to the Threshold Assessment Grid (TAG) ≥ 5 and duration of illness ≥ 2 years; (c) expected contact with the local mental health service during the 12-month observation period; (d) adequate skills in the language of the host countries; and (e) the ability to provide written informed consent. The clinical decision-making styles of clinicians and the patient satisfaction with decisions were assessed using the Clinical Decision Making Style and the Clinical Decision Making Involvement and Satisfaction scales, respectively. Patients were assessed at baseline and 1 year after the recruitment. The sample consisted of 588 patients with severe mental illness, mainly female, with a mean age of 41.69 (±10.74) and a mean duration of illness of 12.5 (±9.27) years. The majority of patients were diagnosed with psychotic (45.75%) or affective disorders (34.01%). At baseline, a shared CDM style was preferred by 70.6% of clinicians and about 40% of patients indicated a high level of satisfaction with the decision and 31% a medium level of satisfaction. Higher participation in clinical decisions was associated with improved social functioning and quality-of-life, and reduced interpersonal conflicts, sense of loneliness, feelings of inadequacy, and withdrawal in friendships after 1 year (p < 0.05). Moreover, a higher satisfaction with decisions was associated with a better quality-of-life (p < 0.0001), reduced symptom severity (p < 0.0001), and a significantly lower illness burden associated with symptoms of distress (p < 0.0001), interpersonal difficulties (p < 0.0001), and problems in social roles (p < 0.05). Our findings clearly show that a higher involvement in and satisfaction of patients with clinical decision-making was associated with better outcomes. More efforts have to be made to increase the involvement of patients in clinical decision-making in routine care settings.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlotta Brandi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Aniko Egerhazi
- Department of Psychiatry and Psychotherapy Clinical Center, University of Debrecen, Debrecen, Hungary
| | | | - Wolfram Kawhol
- Clienia Schlössli AG, Oetwil am See, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics (KPPP), University Hospital of Psychiatry, Zurich, Switzerland
| | - Attila Istvan Kovacs
- Department of Psychiatry and Psychotherapy Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Wulf Rossler
- Department of Psychiatry and Psychotherapy, Charité University of Medicine, Berlin, Germany
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK.,Nord University, Namsos, Norway
| | - Bernd Pushner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Taking a positive psychiatry approach to depression and cognitive decline among older adults. Int Psychogeriatr 2022; 34:605-608. [PMID: 35414374 DOI: 10.1017/s1041610222000394] [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: 11/06/2022]
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