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Hu Q, Feng Z, Zong Q, Wang J, Zheng Z, Feng D. Analysis of factors that promote the participation of patients with chronic diseases in shared decision making on medication: a cross-sectional survey in Hubei Province, China. BMC Public Health 2023; 23:2440. [PMID: 38057751 PMCID: PMC10701977 DOI: 10.1186/s12889-023-17099-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 10/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) improves the health status of patients with chronic diseases, especially in the condition of poly-medicated patients. This study aims to find the factors associated with participation of patients with chronic diseases in SDM on medication. METHODS A total of 1,196 patients with chronic diseases were selected in Hubei Province of China using cluster sampling methods. The random forest method was applied to rank the importance of independent variables by Mean Decrease Gini and out-of- bag (OOB) curve. Multivariate logistic regression was used to explore the independent variables' effect direction and relative hazard. RESULTS In this study, 5.18% of patients used patient-directed decision making (PDM, a decision-making model led by patients), 37.79% of patients used SDM (a collaborative decision-making model by patients and doctors), and 57.02% of patients used doctor-directed decision making (DDM, or paternalistic decision making, a decision-making model led by doctors). The random forest analysis demonstrated that the top 5 important factors were age, education, exercise, disease course, and medication knowledge. The OOB curve showed that the error rate reached minimum when top 5 variables in importance ranking composed an optimal variable combination. In multivariate logistic regression, we chose SDM as a reference group, and identified medication knowledge (OR = 2.737, 95%CI = 1.524 ~ 4.916) as the influencing factor between PDM and SDM. Meanwhile, the influencing factors between DDM and SDM were age (OR = 0.636, 95%CI = 0.439 ~ 0.921), education (OR = 1.536, 95%CI = 1.122 ~ 2.103), exercise (OR = 1.443, 95%CI = 1.109 ~ 1.877), disease course (OR = 0.750, 95%CI = 0.584 ~ 0.964), and medication knowledge (OR = 1.446, 95%CI = 1.120 ~ 1.867). CONCLUSION Most Chinese patients with chronic diseases used DDM during their medication decision-making, and some patients used PDM and SDM. The participation in SDM should be taken seriously among elderly patients with lower education levels. The SDM promotion should focus on transformation of patients' traditional perception and enhance their medication knowledge.
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Affiliation(s)
- Qijun Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiao Zong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jia Wang
- Science and Education Department, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Lau SWY, Law CKM, Ng SM. Validation of the Chinese version stage of recovery instrument-30 (STORI-30) for adults with severe mental illness. BMC Psychiatry 2023; 23:485. [PMID: 37403060 DOI: 10.1186/s12888-023-04954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Stage of Recovery Instrument-30 (STORI-30) is grounded in a five-stage model of psychological recovery, and serves as measuring recovery stage of people with mental illness. AIMS To develop and validate the Chinese version STORI-30 on adults with severe mental illness. METHODS STORI-30 was translated to traditional Chinese through forward-backward method. An expert panel and potential users evaluated face validity and content validity. The Chinese version STORI-30 plus other convergent and divergent scales were then administered to 113 participants for field test. RESULTS Face and content validity were confirmed with acceptable Content Validity Index and high inter-rater agreement. Exploratory factor analysis revealed a three-factor structure. An ordinal sequence was presented among the five subscales, similar to the original version. Construct validity was supported by positive correlations with recovery and mental well-being scales, and negative correlation with self-stigma scale. Good internal consistency (Cronbach's α = 0.78-0.86) and high level of test-retest reliability (Intraclass correlation coefficient = 0.96) were obtained. CONCLUSIONS Chinese STORI-30 presents satisfactory psychometric properties in internal consistency, construct convergent and divergent validity, and test-retest reliability. The three-factor structure revealed does not echo the original five-stage recovery model. Further studies exploring the underlying structure are warranted.
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Affiliation(s)
- Sharon Wing-Yung Lau
- Occupational Therapy Department, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong.
| | - Colin Kwok-Man Law
- Occupational Therapy Department, Castle Peak Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Siu-Man Ng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong.
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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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Rojnic Kuzman M, Slade M, Puschner B, Scanferla E, Bajic Z, Courtet P, Samochowiec J, Arango C, Vahip S, Taube M, Falkai P, Dom G, Izakova L, Carpiniello B, Bellani M, Fiorillo A, Skugarevsky O, Mihaljevic-Peles A, Telles-Correia D, Novais F, Mohr P, Wancata J, Hultén M, Chkonia E, Balazs J, Beezhold J, Lien L, Mihajlovic G, Delic M, Stoppe G, Racetovic G, Babic D, Mazaliauskiene R, Cozman D, Hjerrild S, Chihai J, Flannery W, Melartin T, Maruta N, Soghoyan A, Gorwood P. Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries. Eur Psychiatry 2022; 65:e75. [DOI: 10.1192/j.eurpsy.2022.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe.
Methods
We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice.
Results
SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style.
Conclusions
The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.
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5
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Pappa S, Barnett J, Gomme S, Iliopoulou A, Moore I, Whitaker M, McGrath J, Sie M. Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come? Community Ment Health J 2021; 57:1566-1578. [PMID: 33544295 PMCID: PMC8531065 DOI: 10.1007/s10597-021-00780-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide 'Supported Decision Making in Medication' Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber's perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.
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Affiliation(s)
- Sofia Pappa
- West London NHS Trust, London, UK.
- Dept of Psychiatry, Imperial College London, London, UK.
| | | | | | | | | | | | - Jane McGrath
- West London NHS Trust, London, UK
- We Coproduce CIC, London, UK
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Gurtner C, Schols JMGA, Lohrmann C, Halfens RJG, Hahn S. Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:531-548. [PMID: 33191536 DOI: 10.1111/jpm.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Shared decision-making is a concept originating in the medical field, and it is ideally based on a trustful relationship between the patient and the health professionals involved. Shared decision-making shows potential to strengthen patient autonomy and encourages patients to become involved in decisions regarding their treatment. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: A universal concept and understanding of shared decision-making with relevance specifically to psychiatric clinical practice could not be identified in the analysed literature. Shared decision-making refers to a process, and how and whether the patient wishes to participate in the decision-making process should be clarified from the very beginning. On the basis of this synthesizing review, a process model for psychiatric practice was specified and illustrated to help lead health professionals, patients and other supporters through the decision-making process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The process of shared decision-making should be made visible to all persons involved, and it should be stated at the beginning that a decision must be made. Decisions regarding treatment are usually not limited to a single consultation. A collaborative approach including multiple health professionals and other supporters, such as peer workers and family members, is required. Psychiatric nurses could support patients during the process of decision-making and provide additional information, if requested. ABSTRACT INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision-making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centred and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.
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Affiliation(s)
- Caroline Gurtner
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine & Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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7
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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.
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Razzaque A, Eldabi T, Chen W. Quality decisions from physicians’ shared knowledge in virtual communities. KNOWLEDGE MANAGEMENT RESEARCH & PRACTICE 2020. [DOI: 10.1080/14778238.2020.1788428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Anjum Razzaque
- Management Information Systems, Ahlia University , Manama, Bahrain
| | - Tillal Eldabi
- Department of Business Transformation, University of Surrey , Guildford, UK
| | - Weifeng Chen
- Brunel Business School, Brunel University , Uxbridge, UK
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9
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Morán-Sánchez I, Gómez-Vallés P, Bernal-López MÁ, Pérez-Cárceles MD. Shared decision-making in outpatients with mental disorders: Patients´ preferences and associated factors. J Eval Clin Pract 2019; 25:1200-1209. [PMID: 31373107 DOI: 10.1111/jep.13246] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/11/2019] [Accepted: 07/16/2019] [Indexed: 01/21/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Over the last years, traditional paternalistic model is being questioned. Shared Decision-Making (SDM) model has been proposed as a way to improve patient-physician interaction. Little is known to what extent people with severe mental illness want to be involved in decision-making process. This study evaluates their preferences about making clinical decisions and which variables influence these desires. METHOD One hundred seven patients with DSM diagnoses of bipolar disorder or schizophrenia and 100 Non Psychiatric Comparison (NPC) subjects recruited from mental health and primary care departments completed a self-reported questionnaire about preferences in decision-making process. Demographic and clinical information was obtained through review of available records and the Brief Psychiatric Rating Scale (BPRS). RESULTS Patients and NPCs differed as regards their preferences about their participation in medical decisions. NPCs were 18 times more likely to prefer options about their treatment and 2 times more likely to prefer to take medical decisions by their own than psychiatric patients. The best predictors of the preference of a SDM model were a lower BPRS global score and the absence of previous compulsory admissions. CONCLUSIONS Psychiatric patients more frequently preferred a passive role in the decision-making process. Interventions to promote SDM should be tailored to the values and needs of each patient because not everyone wants to participate to the same degree. We found several factors to take into account in patient engagement in SDM as these populations may be more vulnerable.
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Affiliation(s)
| | - Paula Gómez-Vallés
- Department of Legal Medicine, Regional Campus of International Excellence "Campus Mare Nostrum," Faculty of Medicine, University of Murcia, Cartagena, Spain
| | | | - María Dolores Pérez-Cárceles
- Department of Legal Medicine, Regional Campus of International Excellence "Campus Mare Nostrum," Faculty of Medicine, University of Murcia, Cartagena, Spain
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Roe D, Mazor Y, Gelkopf M. Patient-reported outcome measurements (PROMs) and provider assessment in mental health: a systematic review of the context of implementation. Int J Qual Health Care 2019; 34:ii28–ii39. [DOI: 10.1093/intqhc/mzz084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Purpose
To review and integrate the vast amount of literature yielded by recent growing interest in patient-reported outcome measurement and routine outcome measures (PROMs/ROMs), in order to suggest options and improvements for implementation. PROMs are the systematic assessment of service users’ health using standardized self-report measures. Specifically, for ROMs, it includes routine provider or caretaker assessment measures. Both are administered to ascertain routinely, the impact of treatment in mental health settings and to improve care. A review is needed because of the large differences in setting, conceptualization, practice and implementation. Here, we examine the different major projects worldwide.
Data sources
Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science’s Direct.
Study selection
We conducted a systematized review of the literature published from 2000 to 2018 on the implementation and sustainability of PROMs and ROMs in mental health services for adults.
Data extraction, synthesis and Results
We described and characterized the programs in different countries worldwide. We identified 103 articles that met the inclusion criteria, representing over 80 PROMs/ROMs initiatives in 15 countries. National policy and structure of mental health services were found to be major factors in implementation. We discuss the great variability in PROMs/ROMs models in different countries, making suggestions for their streamlining and improvement.
Conclusion
We extracted valuable information on the different characteristics of the numerous PROMs/ROMs initiatives worldwide. However, in the absence of a strong nationwide policy effort and support, implementation seems scattered and irregular. Thus, development of the implementation of PROMs/ROMs is left to groups of enthusiastic clinicians and researchers, making sustainability problematic.
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Affiliation(s)
- David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
- Department of Clinical Medicine, Psychiatry, Aalborg University, Denmark
| | - Yael Mazor
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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Wanders RBK, Meijer RR, Ruhé HG, Sytema S, Wardenaar KJ, de Jonge P. Person-fit feedback on inconsistent symptom reports in clinical depression care. Psychol Med 2018; 48:1844-1852. [PMID: 29173196 DOI: 10.1017/s003329171700335x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depressive patients can present with complex and different symptom patterns in clinical care. Of these, some may report patterns that are inconsistent with typical patterns of depressive symptoms. This study aimed to evaluate the validity of person-fit statistics to identify inconsistent symptom reports and to assess the clinical usefulness of providing clinicians with person-fit score feedback during depression assessment. METHODS Inconsistent symptom reports on the Inventory of Depressive Symptomatology Self-Report (IDS-SR) were investigated quantitatively with person-fit statistics for both intake and follow-up measurements in the Groningen University Center of Psychiatry (n = 2036). Subsequently, to investigate the causes and clinical usefulness of on-the-fly person-fit alerts, qualitative follow-up assessments were conducted with three psychiatrists about 20 of their patients that were randomly selected. RESULTS Inconsistent symptom reports at intake (12.3%) were predominantly characterized by reporting of severe symptoms (e.g. psychomotor slowing) without mild symptoms (e.g. irritability). Person-fit scores at intake and follow-up were positively correlated (r = 0.45). Qualitative interviews with psychiatrists resulted in an explanation for the inconsistent response behavior (e.g. complex comorbidity, somatic complaints, and neurological abnormalities) for 19 of 20 patients. Psychiatrists indicated that if provided directly after the assessment, a person-fit alert would have led to new insights in 60%, and be reason for discussion with the patient in 75% of the cases. CONCLUSIONS Providing clinicians with automated feedback when inconsistent symptom reports occur is informative and can be used to support clinical decision-making.
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Affiliation(s)
- Rob B K Wanders
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob R Meijer
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoerd Sytema
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas J Wardenaar
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
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Affiliation(s)
- Andrea Fiorillo
- a Department of Psychiatry , University of Campania 'Luigi Vanvitelli' , Naples , Italy
| | - Mario Maj
- a Department of Psychiatry , University of Campania 'Luigi Vanvitelli' , Naples , Italy
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Michaelis S, Kriston L, Härter M, Watzke B, Schulz H, Melchior H. Predicting the preferences for involvement in medical decision making among patients with mental disorders. PLoS One 2017; 12:e0182203. [PMID: 28837621 PMCID: PMC5570317 DOI: 10.1371/journal.pone.0182203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 07/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The involvement of patients in medical decision making has been investigated widely in somatic diseases. However, little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders. OBJECTIVE This study aims to determine what roles mentally ill patients actually want to assume when making medical decisions and to identify the variables that could predict this role, including patients' self-efficacy. METHOD Demographic and clinical data of 798 patients with mental disorders from three psychotherapeutic units in Germany were elicited using self-report questionnaires. Control preference was measured using the Control Preferences Scale, and patients' perceived self-efficacy was assessed using the Self-Efficacy Scale. Bivariate and multivariate regression analyses were conducted to investigate the associations between patient variables and control preference. RESULTS Most patients preferred a collaborative role (57.5%), followed by a semi passive (21.2%), a partly autonomous (16.2%), an autonomous (2.8%) and a fully passive (2.3%) role when making medical decisions. Age, sex, diagnosis, employment status, medical pretreatment and perceived self-efficacy were associated with the preference for involvement in the multivariate logistic model. CONCLUSION Our results confirm the preferences for involvement in medical decisions of mentally ill patients. We reconfirmed previous findings that older patients prefer a shared role over an autonomous role and that subjects with a high qualification prefer a more autonomous role over a shared role. The knowledge about predictors may help strengthen treatment effectiveness because matching the preferred and actual role preferences has been shown to improve clinical outcome.
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Affiliation(s)
- Svea Michaelis
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Watzke
- Department of Psychology - Clinical Psychology and Psychotherapy Research, University of Zürich, Switzerland
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanne Melchior
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is "polyvalent", a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes - social marketing and the hospitality industry - are identified.
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Affiliation(s)
- Mike Slade
- Institute of Mental Health, School of Health Sciences, University of NottinghamNottinghamUK
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Helping Alliance and Unmet Needs in Routine Care of People With Severe Mental Illness Across Europe: A Prospective Longitudinal Multicenter Study. J Nerv Ment Dis 2017; 205:329-333. [PMID: 28350783 DOI: 10.1097/nmd.0000000000000650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p < 0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = -0.10, p < 0.0001) and staff-rated (B = -0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.
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Loos S, Clarke E, Jordan H, Puschner B, Fiorillo A, Luciano M, Ivánka T, Magyar E, Krogsgaard-Bording M, Østermark-Sørensen H, Rössler W, Kawohl W, Mayer B, Slade M. Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study. BMC Psychiatry 2017; 17:38. [PMID: 28114913 PMCID: PMC5260092 DOI: 10.1186/s12888-017-1207-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery. METHODS Data derived from an observational cohort study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR). Adults (aged 18-60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change. RESULTS Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15-2.94) or passive (OR = 1.71, 95% CI = 1.00-2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery. CONCLUSIONS Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
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Affiliation(s)
- Sabine Loos
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany.
| | - Eleanor Clarke
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Bernd Puschner
- 0000 0004 1936 9748grid.6582.9Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312 Günzburg, Germany
| | - Andrea Fiorillo
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Luciano
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Tibor Ivánka
- 0000 0001 1088 8582grid.7122.6Department of Psychiatry, University of Debrecen Medical Centre, Debrecen, Hungary
| | - Erzsébet Magyar
- 0000 0001 1088 8582grid.7122.6Department of Psychiatry, University of Debrecen Medical Centre, Debrecen, Hungary
| | - Malene Krogsgaard-Bording
- 0000 0004 0646 7349grid.27530.33Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Østermark-Sørensen
- 0000 0004 0646 7349grid.27530.33Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Wulf Rössler
- 0000 0004 1937 0650grid.7400.3Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- 0000 0004 1937 0650grid.7400.3Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Benjamin Mayer
- 0000 0004 1936 9748grid.6582.9Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Mike Slade
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Bär Deucher A, Hengartner MP, Kawohl W, Konrad J, Puschner B, Clarke E, Slade M, Del Vecchio V, Sampogna G, Égerházi A, Süveges Á, Krogsgaard Bording M, Munk-Jørgensen P, Rössler W. Participation in medical decision-making across Europe: An international longitudinal multicenter study. Eur Psychiatry 2016; 35:39-46. [PMID: 27061376 DOI: 10.1016/j.eurpsy.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries. METHODS The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations. RESULTS We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 47.2% of total variance in the desire for participation (P<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, the desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable. CONCLUSIONS This study demonstrates that patients' desire for participation in decision-making varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.
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Affiliation(s)
- A Bär Deucher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland.
| | - M P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Pfingstweidstrasse 96, PO Box 707, 8037 Zurich, Switzerland
| | - W Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland
| | - J Konrad
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - B Puschner
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - E Clarke
- Kings College London, Section for Recovery, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - M Slade
- Kings College London, Section for Recovery, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - V Del Vecchio
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - G Sampogna
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - A Égerházi
- Department of Psychiatry, Medical and Health Science Centre, University of Debrecen, 98, Nagyerdei krt, 4012, Debrecen, Hungary
| | - Á Süveges
- Department of Psychiatry, Medical and Health Science Centre, University of Debrecen, 98, Nagyerdei krt, 4012, Debrecen, Hungary
| | - M Krogsgaard Bording
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, Aalborg, 9000, Denmark
| | - P Munk-Jørgensen
- Department M, Aarhus University Hospital, Skovagervej 2, 8240 Risskov, Denmark
| | - W Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland
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Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR). Epidemiol Psychiatr Sci 2016; 25:69-79. [PMID: 25600424 PMCID: PMC6998762 DOI: 10.1017/s204579601400078x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome. METHODS "Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness" (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff. RESULTS Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ 2 = 135.08; p < 0.001) and staff (χ 2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (-0.406 unmet needs per two months, p = 0.007) or shared (-0.303 unmet needs per two months, p = 0.015) decision making. CONCLUSIONS Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.
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Konrad J, Loos S, Neumann P, Zentner N, Mayer B, Slade M, Jordan H, De Rosa C, Del Vecchio V, Égerházi A, Nagy M, Bording MK, Sørensen HØ, Kawohl W, Rössler W, Puschner B. Content and implementation of clinical decisions in the routine care of people with severe mental illness. J Ment Health 2015; 24:15-9. [PMID: 25734210 DOI: 10.3109/09638237.2014.951478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. AIMS To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. METHOD As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. RESULTS Agreement between patients and staff regarding decision making was moderate (k = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. CONCLUSIONS A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.
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van den Brink RHS, Troquete NAC, Beintema H, Mulder T, van Os TWDP, Schoevers RA, Wiersma D. Risk assessment by client and case manager for shared decision making in outpatient forensic psychiatry. BMC Psychiatry 2015; 15:120. [PMID: 26012536 PMCID: PMC4443540 DOI: 10.1186/s12888-015-0500-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/15/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In outpatient forensic psychiatry, assessment of re-offending risk and treatment needs by case managers may be hampered by an incomplete view of client functioning. The client's appreciation of his own problem behaviour is not systematically used for these purposes. The current study tests whether using a new client self-appraisal risk assessment instrument, based on the Short Term Assessment of Risk and Treatability (START), improves the assessment of re-offending risk and can support shared decision making in care planning. METHODS In a sample of 201 outpatient forensic psychiatric clients, feasibility of client risk assessment, concordance with clinician assessment, and predictive validity of both assessments for violent or criminal behaviour were studied. RESULTS Almost all clients (98 %) were able to fill in the instrument. Agreement between client and case manager on the key risk and protective factors of the client was poor (mean kappa for selection as key factor was 0.15 and 0.09, respectively, and mean correlation on scoring -0.18 and 0.20). The optimal prediction model for violent or criminal behaviour consisted of the case manager's structured professional risk estimate for violence in combination with the client's self-appraisal on key risk and protective factors (AUC = 0.70; 95%CI: 0.60-0.80). CONCLUSIONS In outpatient forensic psychiatry, self-assessment of risk by the client is feasible and improves the prediction of re-offending. Clients and their case managers differ in their appraisal of key risk and protective factors. These differences should be addressed in shared care planning. The new Client Self-Appraisal based on START (CSA) risk assessment instrument can be a useful tool to facilitate such shared care planning in forensic psychiatry.
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Affiliation(s)
- Rob H S van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Nadine A C Troquete
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Harry Beintema
- Mental Health Organisation Lentis and Forensic Psychiatric Clinic Dr. S. van Mesdag, Groningen, The Netherlands.
| | - Tamara Mulder
- Mental Health Organisation Drenthe, Assen, The Netherlands.
| | | | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Durk Wiersma
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach. Soc Psychiatry Psychiatr Epidemiol 2015; 50:363-70. [PMID: 25242154 DOI: 10.1007/s00127-014-0963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/08/2014] [Indexed: 01/24/2023]
Abstract
PURPOSE The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year. METHODS Self-ratings of the HA by 588 people with severe mental illness who participated in a multicentre European study (CEDAR; ISRCTN75841675) were examined using latent class analysis. RESULTS Four main patterns of alliance were identified: (1) high and stable (HS, 45.6 %), (2) high and increasing (HI, 36.9 %), (3) high and decreasing (HD, 11.3 %) and (4) low and increasing (LI, 6.1 %). Predictors of class membership were duration of illness, ethnicity, and education, receipt of state benefits, recovery, and quality of life. CONCLUSIONS Results support findings from psychotherapy research about a predominantly stable course of the helping alliance in patients with severe mental illness over time. Implications for research and practice indicate to turn the attention to subgroups with noticeable courses.
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Fukui S, Matthias MS, Salyers MP. Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:40-6. [PMID: 24500023 PMCID: PMC4125549 DOI: 10.1007/s10488-014-0539-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.
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Affiliation(s)
- Sadaaki Fukui
- The University of Kansas School of Social, Welfare Center for Mental Health Research and Innovation, 1545 Lilac Lane Lawrence, KS 66044, U.S. A TEL: (785)864-5874; FAX: (785)864-5277;
| | - Marianne S. Matthias
- Roudebush VA Medical Center and Regenstrief Institute, Adjunct Assistant Professor, Department of Communication Studies, Indiana University-Purdue University Indianapolis, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-4514; FAX: (317)988-5361;
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis; Co-Director, ACT Center of Indiana, 402 N. Blackford Street, LD 124, Indianapolis, IN 46202, TEL: (317) 274-2904
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Giacco D, Luciano M, Del Vecchio V, Sampogna G, Slade M, Clarke E, Nagy M, Egerhazi A, Munk-Jørgensen P, Bording MFK, Kawohl W, Rössler W, Zentner N, Puschner B, Fiorillo A. Desire for information of people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1883-91. [PMID: 24907048 DOI: 10.1007/s00127-014-0901-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/26/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity. METHODS 588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the "Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)" study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information. RESULTS 80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977-1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130-1.508) with their clinician. CONCLUSIONS Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.
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Affiliation(s)
- Domenico Giacco
- Department of Psychiatry, Second University of Naples, Largo Madonna delle Grazie, 80138, Naples, Italy,
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Slade M, Jordan H, Clarke E, Williams P, Kaliniecka H, Arnold K, Fiorillo A, Giacco D, Luciano M, Égerházi A, Nagy M, Bording MK, Sørensen HØ, Rössler W, Kawohl W, Puschner B. The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS). BMC Health Serv Res 2014; 14:323. [PMID: 25066212 PMCID: PMC4115477 DOI: 10.1186/1472-6963-14-323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/15/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) - with versions for patients (CDIS-P) and staff (CDIS-S) - for use in mental health services. METHODS An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. RESULTS After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CONCLUSIONS CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. TRIAL REGISTRATION ISRCTN75841675.
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Affiliation(s)
- Mike Slade
- Section for Recovery (Box P029), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
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Fukui S, Salyers MP, Matthias MS, Collins L, Thompson J, Coffman M, Torrey WC. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community Ment Health J 2014; 50:375-82. [PMID: 23299226 PMCID: PMC3980460 DOI: 10.1007/s10597-012-9584-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock's Informed Decision Making Scale (Braddock et al. 1997, 1999, 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was "exploration of consumer preference," with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.
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Affiliation(s)
- Sadaaki Fukui
- The University of Kansas Center for Research Methods and Data Analysis & School of Social Welfare Office of Mental Health Research and Training, Research Associate, 1545 Lilac Lane Lawrence, KS 66044, U.S. A, TEL: (785)864-5874; FAX: (785)864-5277;
| | - Michelle P. Salyers
- Indiana University-Purdue University Indianapolis School of Science Department of Psychology, Associate Professor, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-4419; FAX:(317)988-2719;
| | - Marianne S. Matthias
- Research Scientist, Roudebush VA Medical Center and Regenstrief Institute Adjunct Assistant Professor, Department of Communication Studies, Indiana University-Purdue University Indianapolis, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-4514; FAX: (317)988-2719;
| | - Linda Collins
- Indiana University-Purdue University Indianapolis School of Science Department of Psychology, 1481 W. 10 Street, Indianapolis, IN 46202, TEL: (317)988-2722; FAX: (317)988-2719;
| | - John Thompson
- University of Kansas School of Social Welfare Office of Mental Health Research and Training, Graduate Research Assistant, 1545 Lilac Lane, Lawrence, KS 66044, TEL:(785)864-4720; FAX: (785)864-5277;
| | - Melinda Coffman
- University of Kansas School of Social Welfare Office of Mental Health Research and Training, Research Assistant, 1545 Lilac Lane, Lawrence, KS 66044, TEL:(785)864-5868; FAX:(785)864-5277;
| | - William C. Torrey
- Dartmouth Medical School Dartmouth-Hitchcock Medical Center Department of Psychiatry, Associate Professor & Vice Chair for Clinical Services, One Medical Center Drive, Lebanon, NH 03756, TEL:(603)650-6069; FAX:(603)650-5842;
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Gibbons CJ, Bee PE, Walker L, Price O, Lovell K. Service user- and carer-reported measures of involvement in mental health care planning: methodological quality and acceptability to users. Front Psychiatry 2014; 5:178. [PMID: 25566099 PMCID: PMC4263079 DOI: 10.3389/fpsyt.2014.00178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/25/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Increasing service user and carer involvement in mental health care planning is a key healthcare priority but one that is difficult to achieve in practice. To better understand and measure user and carer involvement, it is crucial to have measurement questionnaires that are both psychometrically robust and acceptable to the end user. METHODS We conducted a systematic review using the terms "care plan$," "mental health," "user perspective$," and "user participation" and their linguistic variants as search terms. Databases were searched from inception to November 2012, with an update search at the end of September 2014. We included any articles that described the development, validation or use of a user and/or carer-reported outcome measures of involvement in mental health care planning. We assessed the psychometric quality of each instrument using the "Evaluating the Measurement of Patient-Reported Outcomes" (EMPRO) criteria. Acceptability of each instrument was assessed using novel criteria developed in consultation with a mental health service user and carer consultation group. RESULTS We identified eleven papers describing the use, development, and/or validation of nine user/carer-reported outcome measures. Psychometric properties were sparsely reported and the questionnaires met few service user/carer-nominated attributes for acceptability. Where reported, basic psychometric statistics were of good quality, indicating that some measures may perform well if subjected to more rigorous psychometric tests. The majority were deemed to be too long for use in practice. DISCUSSION Multiple instruments are available to measure user/carer involvement in mental health care planning but are either of poor quality or poorly described. Existing measures cannot be considered psychometrically robust by modern standards, and cannot currently be recommended for use. Our review has identified an important knowledge gap, and an urgent need to develop new user and carer measures of care-planning involvement.
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Affiliation(s)
- Chris J Gibbons
- Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester , Manchester , UK ; Centre for Primary Care, Institute of Population Health, University of Manchester , Manchester , UK
| | - Penny E Bee
- School of Nursing Midwifery and Social Work, Institute of Population Health, University of Manchester , Manchester , UK
| | - Lauren Walker
- School of Nursing Midwifery and Social Work, Institute of Population Health, University of Manchester , Manchester , UK
| | - Owen Price
- School of Nursing Midwifery and Social Work, Institute of Population Health, University of Manchester , Manchester , UK
| | - Karina Lovell
- School of Nursing Midwifery and Social Work, Institute of Population Health, University of Manchester , Manchester , UK ; NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester (NIHR CLAHRC-GM), University of Manchester , Manchester , UK
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Razzaque A, Eldabi T, Jalal-Karim A. Physician virtual community and medical decision making. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2013. [DOI: 10.1108/jeim-07-2013-0047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Puschner B, Neumann P, Jordan H, Slade M, Fiorillo A, Giacco D, Égerházi A, Ivánka T, Bording MK, Sørensen HØ, Bär A, Kawohl W, Loos S. Development and psychometric properties of a five-language multiperspective instrument to assess clinical decision making style in the treatment of people with severe mental illness (CDMS). BMC Psychiatry 2013; 13:48. [PMID: 23379280 PMCID: PMC3570278 DOI: 10.1186/1471-244x-13-48] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this study was to develop and evaluate psychometric properties of the Clinical Decision Making Style (CDMS) scale which measures general preferences for decision making as well as preferences regarding the provision of information to the patient from the perspectives of people with severe mental illness and staff. METHODS A participatory approach was chosen for instrument development which followed 10 sequential steps proposed in a current guideline of good practice for the translation and cultural adaptation of measures. Following item analysis, reliability, validity, and long-term stability of the CDMS were examined using Spearman correlations in a sample of 588 people with severe mental illness and 213 mental health professionals in 6 European countries (Germany, UK, Italy, Denmark, Hungary, and Switzerland). RESULTS In both patient and staff versions, the two CDMS subscales "Participation in Decision Making" and "Information" reliably measure distinct characteristics of decision making. Validity could be demonstrated to some extent, but needs further investigation. CONCLUSIONS Together with two other five-language patient- and staff-rated measures developed in the CEDAR study (ISRCTN75841675) - "Clinical Decision Making in Routine Care" and "Clinical Decision Making Involvement and Satisfaction" - the CDMS allows empirical investigation of the complex relation between clinical decision making and outcome in the treatment of people with severe mental illness across Europe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
| | - Petra Neumann
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
| | - Harriet Jordan
- King’s College London, Section for Recovery, Institute of Psychiatry, London, U.K
| | - Mike Slade
- King’s College London, Section for Recovery, Institute of Psychiatry, London, U.K
| | - Andrea Fiorillo
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Domenico Giacco
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Anikó Égerházi
- Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Tibor Ivánka
- Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Malene Krogsgaard Bording
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Østermark Sørensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Arlette Bär
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
| | - Sabine Loos
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
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Yajuan Wang, Simon M, Bonde P, Harris BU, Teuteberg JJ, Kormos RL, Antaki JF. Prognosis of Right Ventricular Failure in Patients With Left Ventricular Assist Device Based on Decision Tree With SMOTE. ACTA ACUST UNITED AC 2012; 16:383-90. [DOI: 10.1109/titb.2012.2187458] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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