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Racz JI, Bialocerkowski A, Calteaux I, Farrell LJ. Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review. Clin Child Fam Psychol Rev 2024:10.1007/s10567-024-00478-3. [PMID: 38630196 DOI: 10.1007/s10567-024-00478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians' negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.
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Affiliation(s)
- J I Racz
- School of Applied Psychology, Griffith University, Southport, QLD, Australia.
| | | | - I Calteaux
- School of Applied Psychology, Griffith University, Southport, QLD, Australia
| | - L J Farrell
- School of Applied Psychology, Griffith University, Southport, QLD, Australia
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2
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Syed A, Jacob MS. Languaging psychopathology: neurobiology and metaphor. Front Psychiatry 2024; 15:1320771. [PMID: 38374980 PMCID: PMC10875027 DOI: 10.3389/fpsyt.2024.1320771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neurobiological models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. New approaches are needed to find a better language for describing (let alone explaining) the experience of mental illness. To address this gap, we draw upon interdisciplinary sources and semiotic theory to characterize the role of metaphor in the conceptualization and communication of psychopathology. We examine the metaphors recruited by contemporary neurobiological models and metaphor's role in facilitating descriptive clarity or evocative creativity, depending on intention and context. These multiple roles reveal the implications of metaphorical reasoning in clinical practice, including cognitive flexibility, personalized communication, and uncertainty tolerance. With this analysis, we propose a clinical approach that embraces the meta-process of ongoing novel metaphor generation and co-elaboration, or languaging metaphors of psychopathology. Our goal is to bring attention to the value of employing ever-evolving, shapeable metaphorical depictions of psychiatric illness: metaphors that enable a capacity for change in individuals and society, reduce stigma, and nurture recovery.
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Affiliation(s)
- Adnan Syed
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael S. Jacob
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Verwijmeren D, Grootens KP. Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care. Community Ment Health J 2024; 60:292-307. [PMID: 37550559 PMCID: PMC10821819 DOI: 10.1007/s10597-023-01170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.
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Affiliation(s)
- Doris Verwijmeren
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands.
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
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4
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Baune BT, Minelli A, Carpiniello B, Contu M, Domínguez Barragán J, Donlo C, Ferensztajn-Rochowiak E, Glaser R, Kelch B, Kobelska P, Kolasa G, Kopeć D, Martínez de Lagrán Cabredo M, Martini P, Mayer MA, Menesello V, Paribello P, Perera Bel J, Perusi G, Pinna F, Pinna M, Pisanu C, Sierra C, Stonner I, Wahner VTH, Xicota L, Zang JCS, Gennarelli M, Manchia M, Squassina A, Potier MC, Rybakowski F, Sanz F, Dierssen M. An integrated precision medicine approach in major depressive disorder: a study protocol to create a new algorithm for the prediction of treatment response. Front Psychiatry 2024; 14:1279688. [PMID: 38348362 PMCID: PMC10859920 DOI: 10.3389/fpsyt.2023.1279688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024] Open
Abstract
Major depressive disorder (MDD) is the most common psychiatric disease worldwide with a huge socio-economic impact. Pharmacotherapy represents the most common option among the first-line treatment choice; however, only about one third of patients respond to the first trial and about 30% are classified as treatment-resistant depression (TRD). TRD is associated with specific clinical features and genetic/gene expression signatures. To date, single sets of markers have shown limited power in response prediction. Here we describe the methodology of the PROMPT project that aims at the development of a precision medicine algorithm that would help early detection of non-responder patients, who might be more prone to later develop TRD. To address this, the project will be organized in 2 phases. Phase 1 will involve 300 patients with MDD already recruited, comprising 150 TRD and 150 responders, considered as extremes phenotypes of response. A deep clinical stratification will be performed for all patients; moreover, a genomic, transcriptomic and miRNomic profiling will be conducted. The data generated will be exploited to develop an innovative algorithm integrating clinical, omics and sex-related data, in order to predict treatment response and TRD development. In phase 2, a new naturalistic cohort of 300 MDD patients will be recruited to assess, under real-world conditions, the capability of the algorithm to correctly predict the treatment outcomes. Moreover, in this phase we will investigate shared decision making (SDM) in the context of pharmacogenetic testing and evaluate various needs and perspectives of different stakeholders toward the use of predictive tools for MDD treatment to foster active participation and patients' empowerment. This project represents a proof-of-concept study. The obtained results will provide information about the feasibility and usefulness of the proposed approach, with the perspective of designing future clinical trials in which algorithms could be tested as a predictive tool to drive decision making by clinicians, enabling a better prevention and management of MDD resistance.
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Affiliation(s)
- Bernhard T. Baune
- Department of Mental Health, University of Münster, Münster, Germany
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Genetics Unit, San Giovanni di Dio Fatebenefratelli Center (IRCCS), Brescia, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Chus Donlo
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | - Rosa Glaser
- Department of Mental Health, University Hospital Münster, Münster, Germany
| | - Britta Kelch
- Department of Mental Health, University Hospital Münster, Münster, Germany
| | - Paulina Kobelska
- Department of Science, Grants and International Cooperation, Poznan University of Medical Sciences, Poznan, Poland
| | - Grzegorz Kolasa
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Dobrochna Kopeć
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Paolo Martini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Miguel-Angel Mayer
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Valentina Menesello
- Genetics Unit, San Giovanni di Dio Fatebenefratelli Center (IRCCS), Brescia, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Júlia Perera Bel
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Giulia Perusi
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marco Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudia Pisanu
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Cesar Sierra
- Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Inga Stonner
- Department of Mental Health, University Hospital Münster, Münster, Germany
| | | | - Laura Xicota
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, United States
| | | | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Genetics Unit, San Giovanni di Dio Fatebenefratelli Center (IRCCS), Brescia, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Alessio Squassina
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marie-Claude Potier
- Paris Brain Institute (ICM), National Centre for Scientific Research (CNRS), Paris, France
| | - Filip Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Ferran Sanz
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), Barcelona, Spain
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Selvin M, Almqvist K, Fogelkvist M, Lundqvist LO, Schröder A. Patient Participation in Forensic Psychiatric Care: The Initial Development and Content Validity of a New Instrument. JOURNAL OF FORENSIC NURSING 2023; 19:204-213. [PMID: 37590943 PMCID: PMC10453349 DOI: 10.1097/jfn.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
ABSTRACT Patient participation is central in modern health care. However, it is a complex phenomenon that lacks a clear definition, and what constitutes participation varies depending on the context and theoretical perspective. It is known that patient participation in forensic psychiatric care is often rated as low by both patients and professionals, and it can be assumed that interventions to increase it are beneficial. In this process, management and staff could benefit from assessing perceived patient participation, and reliable and valid measurement instruments are essential. The aim of this study was to develop an instrument that could be used to measure experiences of participation in forensic psychiatric care from a patient perspective and test it for content validity. A definition of patient participation in forensic psychiatric care was formulated and operationalized in an instrument that an expert group, consisting of patients with ongoing care, evaluated for content validity. In total, 50 items were sorted into five different dimensions: to have good communication, to be involved, to have mutual trust, to trust the care, and to take responsibility. After psychometric testing, the instrument has the potential to become a tool to use in research, clinical work, and development work in the field of forensic psychiatric care. In addition to being used as a measure, the Patient Participation in Forensic Psychiatric Care can also be used to encourage a dialogue about their care and to make both patients and staff more aware of patient participation.
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Affiliation(s)
- Mikael Selvin
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Kjerstin Almqvist
- Department for Social and Psychological Studies, Karlstad University
| | - Maria Fogelkvist
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Lars-Olov Lundqvist
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Agneta Schröder
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
- Faculty of Health, Care and Nursing, Department of Nursing, Norwegian University of Science and Technology (NTNU)
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6
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Percudani ME, Iardino R, Porcellana M, Lisoni J, Brogonzoli L, Barlati S, Vita A. The Patient Journey of Schizophrenia in Mental Health Services: Results from a Co-Designed Survey by Clinicians, Expert Patients and Caregivers. Brain Sci 2023; 13:brainsci13050822. [PMID: 37239294 DOI: 10.3390/brainsci13050822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/29/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Patient Journey Project aims to collect real-world experiences on schizophrenia management in clinical practice throughout all the phases of the disorder, highlighting virtuous paths, challenges and unmet needs. METHODS A 60-item survey was co-designed with all the stakeholders (clinicians, expert patients and caregivers) involved in the patient's journey, focusing on three areas: early detection and management, acute phase management and long-term management/continuity of care. For each statement, the respondents expressed their consensus on the importance and the degree of implementation in clinical practice. The respondents included heads of the Mental Health Services (MHSs) in the Lombardy region, Italy. RESULTS For early diagnosis and management, a strong consensus was found; however, the implementation degree was moderate-to-good. For acute phase management, a strong consensus and a good level of implementation were found. For long-term management/continuity of care, a strong consensus was found, but the implementation level was slightly above the cut-off, with 44.4% of the statements being rated as only moderately implemented. Overall, the survey showed a strong consensus and a good level of implementation. CONCLUSIONS The survey offered an updated evaluation of the priority intervention areas for MHSs and highlighted the current limitations. Particularly, early phases and chronicity management should be further implemented to improve the patient journey of schizophrenia patients.
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Affiliation(s)
- Mauro Emilio Percudani
- Department of Mental Health and Addiction Services, Niguarda Hospital, 20162 Milan, Italy
| | | | - Matteo Porcellana
- Department of Mental Health and Addiction Services, Niguarda Hospital, 20162 Milan, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | | | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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7
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Pérez-Revuelta JI, González-Sáiz F, Pascual-Paño JM, Mongil-San Juan JM, Rodríguez-Gómez C, Muñoz-Manchado LI, Mestre-Morales J, Berrocoso E, Villagrán Moreno JM. Shared decision making with schizophrenic patients: a randomized controlled clinical trial with booster sessions (DECIDE Study). PATIENT EDUCATION AND COUNSELING 2023; 110:107656. [PMID: 36807126 DOI: 10.1016/j.pec.2023.107656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The treatment of schizophrenia requires a prolonged, multidimensional intervention that includes antipsychotic drugs. Treatment adherence is essential to effectively control the disorder. Shared decision-making (SDM) is a strategy, supported by numerous practical and ethical arguments, that seeks to involve patients in the therapeutic process to improve treatment adherence and satisfaction. The use of this model in mental health has been limited for many intrinsic and extrinsic reasons. The results of clinical trials conducted to date have largely been disappointing, potential due to study design-related limitations. AIM/QUESTION To evaluate the efficacy, in terms of treatment adherence and improvement in clinical variables, such as severity of symptoms, days of hospitalization or insight, of a carefully timed SDM model initiated immediately prior to hospital discharge in patients with schizophrenia. METHODS Single-blind, randomized clinical trial in an acute psychiatric care unit within the Andalusian Health Department to compare SDM (experimental group) to treatment as usual (TAU; control group) in a sample of patients hospitalized for an acute episode of schizophrenia or schizoaffective disorder. The study was performed between January 2014 and June 2017. The experimental group participated in SDM sessions prior to discharge with regular booster sessions over the one-year follow-up. The health care team responsible for SDM was predisposed to concordance (LatCon II scale) and received specific training in SDM. A hierarchical multiple linear regression analysis was performed to evaluate the factors independently associated with adherence, controlling for sociodemographic, clinical, and admission-related variables. Variables were assessed at admission, discharge and at 3, 6 and 12 months after discharge during the one year follow up. BARS, DAI, WAI-S, COMRADE and PANSS were used to evaluate adherence, attitude to treatment, therapeutic alliance, satisfaction and confidence with decision and clinical status, respectively. RESULTS A total of 227 schizophrenic patients hospitalized with acute decompensation were evaluated; of these, 102 met all inclusion criteria and were included in the study. Most patients (95%) had prior experience with antipsychotics and most (82%) had experienced related side effects. Despite randomization, psychopathologic severity was greater in the experimental group, with a mean (SD) PANSS score of 104.08 (80) vs. 93.45 (20.30) (p < 0.05). The final regression model to explain adherence was significant (adjusted R2 = 0.384; F [df= 6] = 4.386; p < 0.001), with a direct, significant and independent association with SDM mediated by the number of booster sessions. DISCUSSION Shared decision making with booster sessions appears to increase treatment adherence in patients with severe mental disorders. IMPLICATION ON PRACTICE Ethical, practical, and clinical reasons support the use of strategies designed promote the use of long-term, shared decision-making in psychiatric patients, especially in schizophrenia spectrum disorder.
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Affiliation(s)
- Jose I Pérez-Revuelta
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
| | - Francisco González-Sáiz
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
| | - Juan M Pascual-Paño
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Jose M Mongil-San Juan
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Carmen Rodríguez-Gómez
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Leticia I Muñoz-Manchado
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
| | - Jesús Mestre-Morales
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain.
| | - Esther Berrocoso
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Neuropsychopharmacology and Psychobiology Research Group, Department of Psychology, University of Cádiz, Cádiz, Spain.
| | - Jose Ma Villagrán Moreno
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital General Universitario de Jerez de la Frontera, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento Neurociencias, Área Psiquiatría, Universidad de Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Sever Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain.
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8
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de Beurs E, Oudejans S, Terluin B. A Common Measurement Scale for Self-Report Instruments in Mental Health Care. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2022. [DOI: 10.1027/1015-5759/a000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. The diversity of measures in clinical psychology hampers a straightforward interpretation of test results, complicates communication with the patient, and constitutes a challenge to the implementation of measurement-based care. In educational research and assessment, it is common practice to convert test scores to a common metric, such as T scores. We recommend applying this also in clinical psychology and propose and test a procedure to arrive at T scores approximating a normal distribution that can be applied to individual test scores. We established formulas to estimate normalized T scores from raw scale scores by regressing IRT-based θ scores on raw scores. With data from a large population and clinical samples, we established crosswalk formulas. Their validity was investigated by comparing calculated T scores with IRT-based T scores. IRT and formulas yielded very similar T scores, supporting the validity of the latter approach. Theoretical and practical advantages and disadvantages of both approaches to convert scores to common metrics and alternative approaches are discussed. Provided that scale characteristics allow for their computation, T scores will help to better understand measurement results, which makes it easier for patients and practitioners to use test results in joint decision-making about the course of treatment.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, Faculty of Social Sciences, Leiden University, The Netherlands
- Arkin Mental Health Institute, Amsterdam, The Netherlands
| | | | - Berend Terluin
- EMGO Institute, VU Medical Center, Amsterdam, The Netherlands
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9
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El-Alti L. Shared Decision Making in Psychiatry: Dissolving the Responsibility Problem. HEALTH CARE ANALYSIS 2022; 31:65-80. [PMID: 36462103 PMCID: PMC10126083 DOI: 10.1007/s10728-022-00451-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/04/2022]
Abstract
AbstractPerson centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as the responsibility problem, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients’ potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to do away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model.
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Affiliation(s)
- Leila El-Alti
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, EH11 4BN, Edinburgh, UK.
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Box 200, 405 30, Gothenburg, Sweden.
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10
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Santisteban DA, Mena MP, McCabe BE, Abalo C, Puccinelli M. Comparing individually based and family-based treatments for internalizing, externalizing, and family symptoms in Latino youth. FAMILY PROCESS 2022; 61:1144-1161. [PMID: 35437789 DOI: 10.1111/famp.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/16/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
Rigorous randomized trials that test promising culturally centered treatments for Latino youth and families are needed. This study adds to the knowledge base by comparing the efficacy of Culturally Informed and Flexible Family Treatment for Adolescents (CIFFTA) to an Individually Oriented Treatment-As-Usual (ITAU) in its ability to retain Latino youth and families in treatment, reduce internalizing and externalizing child symptoms, and improve family functioning. CIFFTA uses an adaptive/flexible approach to deliver individual therapy, family therapy, and psycho-educational modules tailored to each family's unique clinical and cultural characteristics. Two hundred Latino adolescents 11-14 years of age completed a baseline assessment, were randomly assigned to CIFFTA or ITAU, then were assessed again after 16 weeks of intervention. Results show that CIFFTA had significantly higher retention (83%) than ITAU (71%), OR = 2.05, p = .036. Youth in both conditions showed significant reductions in youth and parent reported externalizing and internalizing behaviors, and there were no differences in change between conditions. Parents in CIFFTA reported significantly greater reductions in family conflict, d = 0.38, p = .025 than in ITAU. In CIFFTA, children of less acculturated Latino parents showed more improvement than the children of more acculturated parents. In ITAU, the reverse was true, children of more acculturated parents reported more improvement. This evidence of CIFFTA's impact on retention, family conflict, and differential effect depending on cultural values and behaviors, has important implications for the field of Latino psychology and family treatment.
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Affiliation(s)
| | - Maite P Mena
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Coral Gables, Florida, USA
| | - Brian E McCabe
- Department of Special Education, Rehabilitation, and Counseling (SERC), Auburn University, Auburn, Alabama, USA
| | | | - Marc Puccinelli
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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11
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Menear M, Girard A, Dugas M, Gervais M, Gilbert M, Gagnon MP. Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review. PLoS One 2022; 17:e0268649. [PMID: 35687610 PMCID: PMC9187074 DOI: 10.1371/journal.pone.0268649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care. METHODS We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. RESULTS In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. CONCLUSION This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.
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Affiliation(s)
- Matthew Menear
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
- * E-mail:
| | - Ariane Girard
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
| | - Michel Gervais
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Michel Gilbert
- Centre National d’Excellence en Santé Mentale, Quebec, Quebec, Canada
| | - Marie-Pierre Gagnon
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
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12
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de Beurs E, Boehnke JR, Fried EI. Common measures or common metrics? A plea to harmonize measurement results. Clin Psychol Psychother 2022; 29:1755-1767. [PMID: 35421265 PMCID: PMC9796399 DOI: 10.1002/cpp.2742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE There is a great variety of measurement instruments to assess similar constructs in clinical research and practice. This complicates the interpretation of test results and hampers the implementation of measurement-based care. METHOD For reporting and discussing test results with patients, we suggest converting test results into universally applicable common metrics. Two well-established metrics are reviewed: T scores and percentile ranks. Their calculation is explained, their merits and drawbacks are discussed, and recommendations for the most convenient reference group are provided. RESULTS We propose to express test results as T scores with the general population as reference group. To elucidate test results to patients, T scores may be supplemented with percentile ranks, based on data from a clinical sample. The practical benefits are demonstrated using the published data of four frequently used instruments for measuring depression: the CES-D, PHQ-9, BDI-II and the PROMIS depression measure. DISCUSSION Recent initiatives have proposed to mandate a limited set of outcome measures to harmonize clinical measurement. However, the selected instruments are not without flaws and, potentially, this directive may hamper future instrument development. We recommend using common metrics as an alternative approach to harmonize test results in clinical practice, as this will facilitate the integration of measures in day-to-day practice.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical PsychologyLeiden University & Arkin GGZAmsterdamThe Netherlands
| | | | - Eiko I. Fried
- Department of Clinical PsychologyLeiden UniversityLeidenZuid‐HollandThe Netherlands
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Thomas EC, Ben-David S, Treichler E, Roth S, Dixon L, Salzer M, Zisman-Ilani Y. A Systematic Review of Shared Decision-Making Interventions for Service Users With Serious Mental Illnesses: State of the Science and Future Directions. Psychiatr Serv 2021; 72:1288-1300. [PMID: 34369801 PMCID: PMC8570969 DOI: 10.1176/appi.ps.202000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be involved in making decisions about their mental health care. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population. METHODS Systematic searches of the literature through April 2020 were conducted and supplemented by hand searching of reference lists of identified studies. A total of 53 independent studies of SDM interventions that were conducted with service users with serious mental illnesses and that included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two authors. RESULTS Most studies were conducted with middle-age, male, White individuals from Western countries. Interventions fell into the following categories: decision support tools only, multicomponent interventions involving decision support tools, multicomponent interventions not involving decision support tools, and shared care planning and preference elicitation interventions. Most studies were randomized controlled trials with sufficient sample sizes. Outcomes assessed were diverse, spanning decision-making constructs, clinical and functional, treatment engagement or adherence, and other constructs. CONCLUSIONS Findings suggest important future directions for research, including the need to evaluate the impact of SDM in special populations (e.g., young adults and racial-ethnic minority groups); to expand interventions to a broader array of decisions, users, and contexts; and to establish consensus measures to assess intervention effectiveness.
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Affiliation(s)
| | | | - Emily Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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Radovic A, Anderson N, Hamm M, George-Milford B, Fascetti C, Engster S, Lindhiem O. Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study. JMIR Ment Health 2021; 8:e26035. [PMID: 34524090 PMCID: PMC8482166 DOI: 10.2196/26035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/27/2021] [Accepted: 04/29/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents' and parents' reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. OBJECTIVE This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. METHODS We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Nathan Anderson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Megan Hamm
- Center for Research on Healthcare's Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Carrie Fascetti
- Clinical and Translational Science Institute Pediatric PittNet, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stacey Engster
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Clinical and Translational Science Institute Pediatric PittNet, University of Pittsburgh, Pittsburgh, PA, United States
| | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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15
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Chekroud AM, Bondar J, Delgadillo J, Doherty G, Wasil A, Fokkema M, Cohen Z, Belgrave D, DeRubeis R, Iniesta R, Dwyer D, Choi K. The promise of machine learning in predicting treatment outcomes in psychiatry. World Psychiatry 2021; 20:154-170. [PMID: 34002503 PMCID: PMC8129866 DOI: 10.1002/wps.20882] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
For many years, psychiatrists have tried to understand factors involved in response to medications or psychotherapies, in order to personalize their treatment choices. There is now a broad and growing interest in the idea that we can develop models to personalize treatment decisions using new statistical approaches from the field of machine learning and applying them to larger volumes of data. In this pursuit, there has been a paradigm shift away from experimental studies to confirm or refute specific hypotheses towards a focus on the overall explanatory power of a predictive model when tested on new, unseen datasets. In this paper, we review key studies using machine learning to predict treatment outcomes in psychiatry, ranging from medications and psychotherapies to digital interventions and neurobiological treatments. Next, we focus on some new sources of data that are being used for the development of predictive models based on machine learning, such as electronic health records, smartphone and social media data, and on the potential utility of data from genetics, electrophysiology, neuroimaging and cognitive testing. Finally, we discuss how far the field has come towards implementing prediction tools in real-world clinical practice. Relatively few retrospective studies to-date include appropriate external validation procedures, and there are even fewer prospective studies testing the clinical feasibility and effectiveness of predictive models. Applications of machine learning in psychiatry face some of the same ethical challenges posed by these techniques in other areas of medicine or computer science, which we discuss here. In short, machine learning is a nascent but important approach to improve the effectiveness of mental health care, and several prospective clinical studies suggest that it may be working already.
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Affiliation(s)
- Adam M Chekroud
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Spring Health, New York City, NY, USA
| | | | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Akash Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marjolein Fokkema
- Department of Methods and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Zachary Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Robert DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Section for Neurodiagnostic Applications, Ludwig-Maximilian University, Munich, Germany
| | - Karmel Choi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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16
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Morán-Sánchez I, Bernal-López MDLÁ, Salmerón D, Pérez-Cárceles MD. Correlates of preferring a passive role in decision-making among patients with schizophrenia or bipolar disorder. PATIENT EDUCATION AND COUNSELING 2021; 104:1125-1131. [PMID: 33268230 DOI: 10.1016/j.pec.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the factors associated with the persistence of clinician-led style in the therapeutic relationship in cases of serious mental illness, and the conditioning factors that the patients identify as determinants of their health. METHOD Assessment of preferences in the decision-making process and health-related control locus of 107 outpatients with DSM-5 diagnosis of schizophrenia or bipolar disorder. Demographic and clinical information was also obtained through review of available records and using several scales. RESULTS 64.4 % patients preferred to adopt a passive role in the therapeutic relationship. In the multivariate analysis, the preference of playing a passive role in the decision-making process was significantly associated with the elderly, being disabled, or the view that one's health depends on doctors (AUC ROC value: 0.80). CONCLUSIONS Patients with severe mental illness more frequently preferred a passive role in the decision-making process. We found several factors associated with a preference for the "expert role" model. PRACTICE IMPLICATIONS The identified factors may permit care to be tailored to the most probable expectations as regard decision-making. Since the populations concerned may be vulnerable and suffer inequalities in the provision of health services, promoting participation in the care process could help improve clinical parameters ethically.
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Affiliation(s)
- Inés Morán-Sánchez
- Health Service of Murcia, Cartagena Mental Health Centre, Cartagena, Spain.
| | | | - Diego Salmerón
- Health Sciences Department, University of Murcia, Espinardo, Spain
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17
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Selvin M, Almqvist K, Kjellin L, Schröder A. Patient participation in forensic psychiatric care: Mental health professionals' perspective. Int J Ment Health Nurs 2021; 30:461-468. [PMID: 33098186 PMCID: PMC7984362 DOI: 10.1111/inm.12806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
Patient participation is a central concept in modern health care and an important factor in theories/models such as person-centred care, shared decision-making, human rights approaches, and recovery-oriented practice. Forensic psychiatric care involves the treatment of patients with serious mental illnesses who also have committed a crime, and there are known challenges for mental health staff to create a health-promoting climate. The aim of the present study was to describe mental health professionals' perceptions of the concept of patient participation in forensic psychiatric care. Interviews were conducted with 19 professionals and were analysed with a phenomenographic approach. The findings are presented as three descriptive categories comprising five conceptions in an hierarchic order: 1. create prerequisites - to have good communication and to involve the patient, 2. adapt to forensic psychiatric care conditions - to take professional responsibility and to assess the patient's current ability, and 3. progress - to encourage the patient to become more independent. The findings highlight the need for professionals to create prerequisites for patient participation through good communication and involving the patient, whilst adapting to forensic psychiatric care conditions by taking professional responsibility, assessing the patient's ability, and encouraging the patient to become more independent without adding any risks to the care process. By creating such prerequisites adapted to the forensic psychiatric care, it is more likely that the patients will participate in their care and take more own responsibility for it, which also may be helpful in the patient recovery process.
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Affiliation(s)
- Mikael Selvin
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Kjerstin Almqvist
- Department for Social and Psychological StudiesKarlstad UniversityKarlstadSweden
| | - Lars Kjellin
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Agneta Schröder
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of Health ScienceFaculty of Health, Care and NursingNorwegian University of Science and Technology (NTNU)GjövikNorway
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18
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Goodsmith N, Cohen AN, Flynn AWP, Hamilton AB, Hellemann G, Nowlin-Finch N, Young AS. Computerized Conjoint Analysis of the Weight Treatment Preferences of Individuals With Schizophrenia. Psychiatr Serv 2021; 72:288-294. [PMID: 33430650 PMCID: PMC7920898 DOI: 10.1176/appi.ps.202000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Innovative approaches are needed for assessing treatment preferences of individuals with schizophrenia. Conjoint analysis methods may help to identify preferences, but the usability and validity of these methods for individuals with schizophrenia remain unclear. This study examined computerized conjoint analysis for persons with schizophrenia and whether preferences for weight management programs predict service use. METHODS A computerized, patient-facing conjoint analysis system was developed through iterative consultation with 35 individuals with schizophrenia enrolled at a community mental health clinic. An additional 35 overweight participants with schizophrenia then used the system to choose among psychosocial weight management programs varying in four attributes: location (community or clinic), delivery mode (Internet or in person), leader (clinician or layperson), and training mode (individual or group). A multilevel logit model with partial preference data determined contributions of each attribute to groupwide preferences. Associations were studied between preferences and use of a psychosocial weight management group. RESULTS Conjoint analysis system usability was rated highly. Groupwide preferences were significantly influenced by location (p<0.001; clinic was preferred), leader (p=0.02; clinician was preferred), and training mode (p<0.001; group was preferred) but not delivery mode (p=0.68). Preferences did not correlate with age, gender, body mass index, illness severity, or subsequent program use. Participants described barriers to program attendance, including transportation, scheduling, privacy, psychiatric illness, and lack of motivation. CONCLUSIONS Computerized conjoint analysis can produce valid assessments of treatment preferences of persons with schizophrenia and inform treatment development and implementation. Although preferences may affect treatment use, they are one of multiple factors.
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Affiliation(s)
- Nichole Goodsmith
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Amy N Cohen
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Anthony W P Flynn
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Alison B Hamilton
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Gerhard Hellemann
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Nancy Nowlin-Finch
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Alexander S Young
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
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19
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Ashoorian DM, Davidson RM. Shared decision making for psychiatric medication management: a summary of its uptake, barriers and facilitators. Int J Clin Pharm 2021; 43:759-763. [PMID: 33515136 DOI: 10.1007/s11096-021-01240-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
The model of shared decision making with mental health patients and clinicians (doctors and pharmacists) harnesses the benefits of patients becoming partners in their own recovery through improved communication and greater self-advocacy. Shared decision making in mental health services is an emerging model of care which has not been well investigated, however it is seen as the way forward to achieving improved health outcomes for non-pharmacological and pharmacological therapy. Successful implementation of this model requires supporting the process through provision of information and training, use of decision aids, coaching in communication skills and inclusion of family and carers in the decision making process. This summary examines the application of the shared decision making model for psychiatric medication management, including barriers and facilitators.
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Affiliation(s)
- Deena M Ashoorian
- Pharmacy Division/ School of Allied Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Rowan M Davidson
- Pharmacy Division/ School of Allied Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
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20
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Hopwood M. The Shared Decision-Making Process in the Pharmacological Management of Depression. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:23-30. [PMID: 31544218 PMCID: PMC6957572 DOI: 10.1007/s40271-019-00383-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Shared decision making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. There is an international consensus across medicine about the importance of SDM interventions, which have raised great interest in mental healthcare over the last decade. Yet SDM is not widely adopted, particularly in the field of psychiatry. The purpose of the present article is to examine, from a patient and physician perspective, the importance of SDM in the management of healthcare with a focus on mental health; it reviews the enablers and barriers (and how to overcome them) to implementing a SDM process in psychiatric practice. SDM models have been developed recently for involving patients with depression in the decision-making process, which could result in augmenting the proportion of patients who adhere to their antidepressant or other treatments for a duration that complies with the current recommendations. To implement this approach, more physicians need training in the SDM approach and access to appropriate tools that help engage in collaborative deliberation, and practice generally needs to be reorganized around the principles of patient engagement.
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Affiliation(s)
- Malcom Hopwood
- Albert Road Clinic, University of Melbourne, Melbourne, Australia.
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21
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Alegiani AC, Rahn AC, Steckelberg A, Thomalla G, Heesen C, Köpke S. Quality of Stroke Patient Information Applied in Randomized Controlled Trials-Literature Review. Front Neurol 2020; 11:526515. [PMID: 33365010 PMCID: PMC7750452 DOI: 10.3389/fneur.2020.526515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Strokes have a huge impact on patients' quality of life. Although there are potentially effective secondary preventions and treatment options for stroke patients, adherence is mostly low. Low disease and treatment-related knowledge and, consequently, a lack of informed decision-making in stroke patients may contribute to this problem. However, stroke patient information did not seem to have relevant effects on patients' knowledge in randomized controlled trials. One contributing factor may be the lack of thoroughly developed patient information materials. Methods: We aimed to evaluate the quality of patient information materials for stroke patients by using randomized controlled trials, applying quality criteria for evidence-based patient information (EBPI). We conducted a literature search (MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL). To be included in the review, research had to be randomized controlled trials that provided stroke patient information, were published in English, and had knowledge assessed as the primary endpoint. Authors of primary studies were contacted and asked for information materials applied. Results: We screened 15,507 hits and identified 30 eligible studies. Information materials were available for only eight studies. Analyses revealed that all available materials had important shortcomings concerning EBPI quality criteria [concerning, for example, structural information (e.g., reporting conflicts of interest), content information (e.g., reporting sources of information), or comprehensive descriptions of treatment effects and side effects]. Frequently, treatment effects were reported only narratively without providing absolute numbers, values, or frequencies. Conclusion: Quality of materials differed, but none sufficiently fulfilled EBPI quality criteria. Unsatisfactory trial results concerning patient knowledge and patient involvement in decision-making may at least partially be explained by limitations of the provided materials. Future patient information should consider EBPI quality criteria.
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Affiliation(s)
- Anna C Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne C Rahn
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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22
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Rowan AB, Grove J, Solfelt L, Magnante A. Reducing the Impacts of Mental Health Stigma Through Integrated Primary Care: An Examination of the Evidence. J Clin Psychol Med Settings 2020; 28:679-693. [PMID: 32990889 DOI: 10.1007/s10880-020-09742-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
The reduction of mental health stigma (MHS) was an expected benefit of integrating behavioral health in primary care (IPC). However, unlike other barriers discussed in agency reports on IPC, discussions of MHS lack research support. To fill this gap, the authors conducted a literature review identifying seven studies. Given the dearth of research, we also examine general IPC research on probable indicators of MHS reduction in IPC, as well as, facets of IPC potentially influencing MHS related factors negatively associated with help-seeking. Using the data from these three types of research, the evidence suggests the potential of IPC to reduce MHS impact on care utilization, but indicates it is premature to draw firm conclusions. Given the possible benefits of primary care and the known benefits of decreased MHS, this review highlights the importance of further research examining this question and provides specific research and program development recommendations.
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Affiliation(s)
- Anderson B Rowan
- School of Psychology and Counseling, Regent University, 1000 Regent University Dr, CRB 161, Virginia Beach, VA, 23464, USA.
| | - Jessica Grove
- School of Psychology and Counseling, Regent University, 1000 Regent University Dr, CRB 161, Virginia Beach, VA, 23464, USA
| | - Lindsay Solfelt
- School of Psychology and Counseling, Regent University, 1000 Regent University Dr, CRB 161, Virginia Beach, VA, 23464, USA
| | - Anna Magnante
- School of Psychology and Counseling, Regent University, 1000 Regent University Dr, CRB 161, Virginia Beach, VA, 23464, USA
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23
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Matejkowski J, Severson ME. Predictors of shared decision making with people who have a serious mental illness and who are under justice supervision in the community. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 70:101568. [PMID: 32482304 DOI: 10.1016/j.ijlp.2020.101568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
Shared decision making (SDM) can be an effective method for promoting service involvement among persons with serious mental illness (SMI). This survey study sought to identify predictors of positive attitudes toward the use of SDM with people with SMI who are living under probation and parole supervision. Supervising officers' (n = 291) perceptions of the capabilities of supervisees with SMI to contribute to their supervision plans, and their familiarity with recovery-oriented mental health services, were positively associated with attitudes toward using SDM. Training officers in common human goals and mental health recovery may advance SDM with supervisees with SMI.
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Affiliation(s)
- Jason Matejkowski
- The University of Kansas School of Social Welfare, 1545 Lilac Lane; 201 Twente Hall, Lawrence, Kansas 66045, United States of America.
| | - Margaret E Severson
- The University of Kansas School of Social Welfare, 1545 Lilac Lane; 201 Twente Hall, Lawrence, Kansas 66045, United States of America.
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24
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Rodenburg-Vandenbussche S, Carlier I, van Vliet I, van Hemert A, Stiggelbout A, Zitman F. Patients' and clinicians' perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders, and obsessive-compulsive disorder in specialized psychiatric care. J Eval Clin Pract 2020; 26:645-658. [PMID: 31612578 DOI: 10.1111/jep.13285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES People worldwide are affected by psychiatric disorders that lack a "best" treatment option. The role of shared decision-making (SDM) in psychiatric care seems evident, yet remains limited. Research on SDM in specialized mental health is scarce, concentrating on patients with depressive disorder or psychiatric disorders in general and less on patients with anxiety and obsessive-compulsive disorder (OCD). Furthermore, recent research concentrates on the evaluation of interventions to promote and measure SDM rather than on the feasibility of SDM in routine practice. This study investigated patients' and clinicians' perspectives on SDM to treat depression, anxiety disorders, and OCD as to better understand SDM in specialized psychiatric care and its challenges in clinical practice. METHODS Transcripts of eight focus groups with 17 outpatients and 33 clinicians were coded, and SDM-related codes were analysed using thematic analyses. RESULTS Motivators, responsibilities, and preconditions regarding SDM were defined. Patients thought SDM should be common practice given the autonomy they have over their own bodies and felt responsible for their treatments. Clinicians value SDM for obtaining patients' consent, promoting treatment adherence, and establishing a good patient-clinician relationship. Patients and clinicians thought clinicians assumed the most responsibility regarding the initiation and achievement of SDM in clinical practice. According to clinicians, preconditions were often not met, were influenced by illness severity, and formed important barriers (eg, patient's decision-making capacity, treatment availability, and clinicians' preferences), leading to paternalistic decision-making. Patients recognized these difficulties, but felt none of these preclude the implementation of SDM. Personalized information and more consultation time could facilitate SDM. CONCLUSIONS Patients and clinicians in specialized psychiatric care value SDM, but adapting it to daily practice remains challenging. Clinicians are vital to the implementation of SDM and should become versed in how to involve patients in the decision-making process, even when this is difficult.
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Affiliation(s)
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Irene van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Albert van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anne Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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25
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James R, Maude P, McGrath I. Advance Statements within the Victorian Mental Health Setting: A Contextual and Legislative Global Comparison. Issues Ment Health Nurs 2020; 41:355-365. [PMID: 31714802 DOI: 10.1080/01612840.2019.1652871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides context to the establishment of advance statements within the Australian mental health setting, in the state of Victoria. A movement to legislate for a more humane and liberal approach to mental health consumer care resulted in changes to the Victorian Mental Health Act (2014a). This Act mirrored legislative changes across the western world and resulted in a socially progressive movement embracing recovery focussed care and consumer clinician partnerships. Thus, we purport that an identified need for a more liberal way to work with individuals who have a diagnosis of mental ill health was a major aim of this law reform. The advance statement model is seen as a tool in addressing a growing recognition of how mental health providers engage consumers of mental health services, and value their preferences to care received. This article arises from a larger study which has aimed to explore the role and scope of advance statements. This research has sought to demonstrate how advanced statements can be used within mental health services by providing recommendations for the mental health nursing workforce in relation to the implementation and deliverables for training.
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Affiliation(s)
- Russell James
- Department of Nursing, University of Tasmania, Hobart, TAS, Australia.,School of Health Sciences, RMIT University, Bundoora, VIC, Australia
| | - Phil Maude
- Department of Nursing, University of Tasmania, Hobart, TAS, Australia.,School of Health Sciences, RMIT University, Bundoora, VIC, Australia
| | - Ian McGrath
- School of Health Sciences, RMIT University, Bundoora, VIC, Australia
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26
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Söderberg A, Wallinius M, Hörberg U. An Interview Study of Professional Carers' Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting. Issues Ment Health Nurs 2020; 41:201-210. [PMID: 31765239 DOI: 10.1080/01612840.2019.1658833] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patient participation in forensic psychiatric settings seems to be complex by nature, and previous studies show that patients rate their participation as lower in this context compared to general psychiatric contexts. Studies on caregivers' perspective could provide a clearer picture of the components and possibilities of patient participation in forensic psychiatry. The aim of the study is to describe carers' experiences in supporting patient participation in a maximum security forensic psychiatric care setting. Twelve psychiatric caregivers were interviewed about how they support patients' participation. The result shows that a complexity of patient participation emerges as a difficult act of balancing the paradoxical role of caring for the patient's interests and development, while simultaneously representing and adhering to the rules and regulations of the system in which one is employed. In conclusion, it is suggested that participation is comprehended as an umbrella term and that focus is directed to conceptualising what caregivers can do in order to create positive patient-carer relationships, as well as what constitutes such a relationship.
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Affiliation(s)
- Andreas Söderberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Märta Wallinius
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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27
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Thomas EC, Zisman-Ilani Y, Salzer MS. Self-Determination and Choice in Mental Health: Qualitative Insights From a Study of Self-Directed Care. Psychiatr Serv 2019; 70:801-807. [PMID: 31109262 PMCID: PMC6718300 DOI: 10.1176/appi.ps.201800544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
SELF-DETERMINATION AND CHOICE IN MENTAL HEALTH.
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Affiliation(s)
| | | | - Mark S Salzer
- College of Public Health, Temple University, Philadelphia
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28
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de Beurs E, Warmerdam L, Twisk J. Bias through selective inclusion and attrition: Representativeness when comparing provider performance with routine outcome monitoring data. Clin Psychol Psychother 2019; 26:430-439. [PMID: 30882974 PMCID: PMC6766975 DOI: 10.1002/cpp.2364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/09/2022]
Abstract
Background Observational research based on routine outcome monitoring is prone to missing data, and outcomes can be biased due to selective inclusion at baseline or selective attrition at posttest. As patients with complete data may not be representative of all patients of a provider, missing data may bias results, especially when missingness is not random but systematic. Methods The present study establishes clinical and demographic patient variables relevant for representativeness of the outcome information. It applies strategies to estimate sample selection bias (weighting by inclusion propensity) and selective attrition bias (multiple imputation based on multilevel regression analysis) and estimates the extent of their impact on an index of provider performance. The association between estimated bias and response rate is also investigated. Results Provider‐based analyses showed that in current practice, the effect of selective inclusion was minimal, but attrition had a more substantial effect, biasing results in both directions: overstating and understating performance. For 22% of the providers, attrition bias was estimated to be in excess of 0.05 ES. Bias was associated with overall response rate (r = .50). When selective inclusion and attrition bring providers' response below 50%, it is more likely that selection bias increased beyond a critical level, and conclusions on the comparative performance of such providers may be misleading. Conclusions Estimates of provider performance were biased by selection, especially by missing data at posttest. Results on the extent and direction of bias and minimal requirements for response rates to arrive at unbiased performance indicators are discussed.
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Affiliation(s)
- Edwin de Beurs
- Clinical Psychology, Leiden University, Leiden, The Netherlands.,Research Department, Stichting Benchmark GGZ, Bilthoven, The Netherlands
| | - Lisanne Warmerdam
- Research Department, Stichting Benchmark GGZ, Bilthoven, The Netherlands
| | - Jos Twisk
- Methodology and Applied Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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29
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Shared decision-making in mental health care using routine outcome monitoring: results of a cluster randomised-controlled trial. Soc Psychiatry Psychiatr Epidemiol 2019; 54:209-219. [PMID: 30151651 DOI: 10.1007/s00127-018-1589-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients' perception of Decisional Conflict (DC), which measures patients' engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes. METHOD Multi-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC. RESULTS Seven teams were randomised to each arm. T0 was completed by 186 patients (51% intervention; 49% control) and T1 by 158 patients (51% intervention, 49% control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =- 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = - 0.45; ROM: p = 0.021, d = - 0.32), which was associated with better treatment outcomes. CONCLUSION Except for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR.
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30
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Chakrabarti S. Treatment alliance and adherence in bipolar disorder. World J Psychiatry 2018; 8:114-124. [PMID: 30425942 PMCID: PMC6230924 DOI: 10.5498/wjp.v8.i5.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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31
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Mercer K, Burns C, Guirguis L, Chin J, Dogba MJ, Dolovich L, Guénette L, Jenkins L, Légaré F, McKinnon A, McMurray J, Waked K, Grindrod KA. Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. JMIR Hum Factors 2018; 5:e24. [PMID: 30274959 PMCID: PMC6231837 DOI: 10.2196/humanfactors.9891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/23/2018] [Accepted: 06/24/2018] [Indexed: 01/19/2023] Open
Abstract
Background Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.
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Affiliation(s)
- Kathryn Mercer
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Catherine Burns
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada.,Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jessie Chin
- Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Lisa Dolovich
- Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Line Guénette
- Population Health and Optimal Health Practices, CHU de Québec Research Centre, Université Laval, Ville de Québec, QC, Canada.,Faculté de pharmacie, Université Laval, Ville de Québec, QC, Canada
| | | | - France Légaré
- Faculty of Medicine, Université Laval, Ville de Québec, QC, Canada
| | | | - Josephine McMurray
- Lazaridis School of Business and Economics, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Khrystine Waked
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Kelly A Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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32
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Role preferences of patients with alcohol use disorders. Addict Behav 2018; 84:248-254. [PMID: 29754065 DOI: 10.1016/j.addbeh.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/21/2022]
Abstract
AIMS Shared decision making (SDM) is increasingly demanded in medical decision making. SDM acknowledges patients' role preferences in decision making processes. There has been limited research on SDM and role preferences in substance use disorders; results are promising. Aim of this study was to investigate role preferences of patients with alcohol use disorders (AUD), and to identify predictors of these preferences. METHOD Cross-sectional data collected from June 2013 to May 2014 in four detoxification wards in Germany during a randomised controlled trial (RCT, Registration Code 01GY1114) was analysed. Of the 250 patients with AUD who were included in the RCT, data from 242 patients [65% male; mean age = 45.2 years (sd = 10.3)] were analysed. Participants' role preferences were assessed with the Control Preference Scale. Potential correlates were drawn from instruments used in the RCT; multinomial logistic regression was used. RESULTS 90% (n = 217) of the AUD patients preferred an active or shared role in decision-making, 10% (n = 25) preferred a passive role. Patients' desire for help was associated with their role preference (OR = 3.087, p = .05). The model's goodness of fit was Nagelkerke's R2 = 0.153 [χ2 (24) = 25.206, p = .395]. CONCLUSIONS Patients' preference for an active role in decision-making underscores the importance of involving patients in their treatment planning. Patients' desire for help seems to be an important determinant of paternalistic decision making. However, further research is needed to determine whether patients' role preferences are related to their behavior during their treatment referral and recovery.
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33
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Metz M, Elfeddali I, Veerbeek M, de Beurs E, Beekman A, van der Feltz-Cornelis C. Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making: A cluster randomised controlled trial in a specialist mental health outpatient setting. PLoS One 2018; 13:e0199795. [PMID: 29944712 PMCID: PMC6019395 DOI: 10.1371/journal.pone.0199795] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process. METHODS The study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored. RESULTS At T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (β 7.553, p = 0.038, 95%CI:0.403-14.703, d = 0.32) and reduction of symptoms (β -7.276, p = 0.0497, 95%CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (β = -0.457, p = 0.000, 95%CI:-0.518--0.396, d = -1.31), which was associated with better treatment outcomes. CONCLUSION Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.
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Affiliation(s)
- Margot Metz
- GGz Breburg, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
- VU University, EMGO, Amsterdam, The Netherlands
| | - Iman Elfeddali
- GGz Breburg, Tilburg, The Netherlands
- Tilburg University, Tranzo Department, Tilburg, The Netherlands
| | | | - Edwin de Beurs
- Foundation for Benchmarking Mental Health Care, Bilthoven, The Netherlands
- University of Leiden, Department of Clinical Psychology, Leiden, The Netherlands
| | - Aartjan Beekman
- GGZ inGeest, Amsterdam, The Netherlands
- VU University Medical Centre, Department of Psychiatry, Amsterdam, The Netherlands
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Alegria M, Nakash O, Johnson K, Ault-Brutus A, Carson N, Fillbrunn M, Wang Y, Cheng A, Harris T, Polo A, Lincoln A, Freeman E, Bostdorf B, Rosenbaum M, Epelbaum C, LaRoche M, Okpokwasili-Johnson E, Carrasco M, Shrout PE. Effectiveness of the DECIDE Interventions on Shared Decision Making and Perceived Quality of Care in Behavioral Health With Multicultural Patients: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:325-335. [PMID: 29466533 PMCID: PMC5875387 DOI: 10.1001/jamapsychiatry.2017.4585] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/17/2017] [Indexed: 01/27/2023]
Abstract
Importance Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care. Objective To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample. Design, Setting, and Participants This cross-level 2 × 2 randomized clinical trial included clinicians at level 2 and patients (nested within clinicians) at level 1 from 13 Massachusetts behavioral health clinics. Clinicians and patients were randomly selected at each site in a 1:1 ratio for each 2-person block. Clinicians were recruited starting September 1, 2013; patients, starting November 3, 2013. Final data were collected on September 30, 2016. Data were analyzed based on intention to treat. Interventions The clinician intervention consisted of a workshop and as many as 6 coaching telephone calls to promote communication and therapeutic alliance to improve SDM. The 3-session patient intervention sought to improve SDM and quality of care. Main Outcomes and Measures The SDM was assessed by a blinded coder based on clinical recordings, patient perception of SDM and quality of care, and clinician perception of SDM. Results Of 312 randomized patients, 212 (67.9%) were female and 100 (32.1%) were male; mean (SD) age was 44.0 (15.0) years. Of 74 randomized clinicians, 56 (75.7%) were female and 18 (4.3%) were male; mean (SD) age was 39.8 (12.5) years. Patient-clinician pairs were assigned to 1 of the following 4 design arms: patient and clinician in the control condition (n = 72), patient in intervention and clinician in the control condition (n = 68), patient in the control condition and clinician in intervention (n = 83), or patient and clinician in intervention (n = 89). All pairs underwent analysis. The clinician intervention significantly increased SDM as rated by blinded coders using the 12-item Observing Patient Involvement in Shared Decision Making instrument (b = 4.52; SE = 2.17; P = .04; Cohen d = 0.29) but not as assessed by clinician or patient. More clinician coaching sessions (dosage) were significantly associated with increased SDM as rated by blinded coders (b = 12.01; SE = 3.72; P = .001; Cohen d = 0.78). The patient intervention significantly increased patient-perceived quality of care (b = 2.27; SE = 1.16; P = .05; Cohen d = 0.19). There was a significant interaction between patient and clinician dosage (b = 7.40; SE = 3.56; P = .04; Cohen d = 0.62), with the greatest benefit when both obtained the recommended dosage. Conclusions and Relevance The clinician intervention could improve SDM with minority populations, and the patient intervention could augment patient-reported quality of care. Trial Registration clinicaltrials.gov Identifier: NCT01947283.
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Affiliation(s)
- Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ora Nakash
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
- Baruch Ivcher School of Psychology Interdisciplinary Center, Herzliya, Israel
| | - Kirsten Johnson
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Andrea Ault-Brutus
- Mental Health Innovation Laboratory, New York City Department of Health and Mental Hygiene, New York City, New York
| | - Nicholas Carson
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Mirko Fillbrunn
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
| | - Alice Cheng
- Department of Psychology, University of Hartford, Hartford, Connecticut
| | - Treniece Harris
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Antonio Polo
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Alisa Lincoln
- Department of Sociology and Heath Sciences, Institute on Urban Health Research, Northeastern University, Boston, Massachusetts
| | - Elmer Freeman
- Office of Urban Health Programs, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
- Center for Community Health Education Research and Service, Inc, Northeastern University, Boston, Massachusetts
| | | | | | - Claudia Epelbaum
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martin LaRoche
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
| | | | | | - Patrick E. Shrout
- Department of Psychology, New York University, New York City, New York
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Alegría M, Alvarez K, Ishikawa RZ, DiMarzio K, McPeck S. Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 2018; 35:991-9. [PMID: 27269014 PMCID: PMC5027758 DOI: 10.1377/hlthaff.2016.0029] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite decades of research, racial and ethnic disparities in behavioral health care persist. The Affordable Care Act expanded access to behavioral health care, but many reform initiatives fail to consider research about racial/ethnic minorities. Mistaken assumptions that underlie the expansion of behavioral health care run the risk of replicating existing service disparities. Based on a review of relevant literature and numerous observational and field studies with minority populations, we identified the following three mistaken assumptions: Improvement in health care access alone will reduce disparities, current service planning addresses minority patients' preferences, and evidence-based interventions are readily available for diverse populations. We propose tailoring the provision of care to remove obstacles that minority patients face in accessing treatment, promoting innovative services that respond to patients' needs and preferences, and allowing flexibility in evidence-based practice and the expansion of the behavioral health workforce. These proposals should help meet the health care needs of a growing racial/ethnic minority population.
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Affiliation(s)
- Margarita Alegría
- Margarita Alegría is a professor of psychology in the Department of Psychiatry at Harvard Medical School and chief of the Disparities Research Unit, Department of Medicine, at Massachusetts General Hospital (MGH), both in Boston
| | - Kiara Alvarez
- Kiara Alvarez is a postdoctoral research fellow in the Disparities Research Unit, Department of Medicine, at MGH
| | - Rachel Zack Ishikawa
- Rachel Zack Ishikawa is project director in the Disparities Research Unit, Department of Medicine, at MGH
| | - Karissa DiMarzio
- Karissa DiMarzio is a research assistant in the Disparities Research Unit, Department of Medicine, at MGH
| | - Samantha McPeck
- Samantha McPeck is a research assistant in the Disparities Research Unit, Department of Medicine, at MGH
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Metz MJ, Veerbeek MA, van der Feltz-Cornelis CM, de Beurs E, Beekman ATF. Decisional conflict in mental health care: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:161-169. [PMID: 29209746 DOI: 10.1007/s00127-017-1467-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Decisional conflict refers to the degree to which patients are engaged in and feel comfortable about important clinical decisions. Until now, the concept has received little attention in mental health care. We investigate the level of decisional conflict in mental health care and whether this is influenced by socio-demographics, treatment setting, diagnoses, and locus of control. METHODS Cross-sectional study among 186 patients in Dutch specialist mental health care using the Decisional Conflict Scale, which measures five dimensions of decisional conflict: information, support, clarification of values, certainty, and decisional quality. Descriptive statistics and forward stepwise linear regression analyses were used. RESULTS Patients report relatively high levels of decisional conflict, especially those with more external locus of control. Having a personality disorder and higher education also increases decisional conflict on the dimensions support and clarification of values, respectively. Less decisional conflict was experienced by patients with psychotic disorders on the dimension certainty and by women on the information domain. CONCLUSIONS Decisional conflict is common among patients in specialist mental health care and is very useful for assessing the quality of clinical decision making. Measuring decisional conflict and knowledge about influencing factors can be used to improve patients' participation in clinical decision making, adherence to treatment and clinical outcomes.
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Affiliation(s)
- Margot J Metz
- GGz Breburg, Postbus 770, 5000, AT, Tilburg, The Netherlands.
- Trimbos Institute, Postbus 725, 3500, AS, Utrecht, The Netherlands.
- VU University, De Boelelaan 1105, 1081, HV, Amsterdam, The Netherlands.
| | | | - Christina M van der Feltz-Cornelis
- GGz Breburg, Postbus 770, 5000, AT, Tilburg, The Netherlands
- Tilburg University, Postbus 90153, 5000, LE, Tilburg, The Netherlands
| | - Edwin de Beurs
- Foundation for Benchmarking Mental Health Care, Rembrandtlaan 46, 3723, BK, Bilthoven, The Netherlands
- University of Leiden, Postbus 9500, 2300, RA, Leiden, The Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest, A.J. Ernststraat 1187, 1081, HL, Amsterdam, The Netherlands
- VU University Medical Centre Amsterdam, Postbus 7057, 1007, MB, Amsterdam, The Netherlands
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Pedley R, McWilliams C, Lovell K, Brooks H, Rushton K, Drake RJ, Rumbold B, Bell V, Bee P. Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing. BJPsych Open 2018; 4:5-14. [PMID: 29388908 PMCID: PMC6020265 DOI: 10.1192/bjo.2017.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/26/2017] [Accepted: 11/09/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication. Aims To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions. METHOD Systematic thematic synthesis. RESULTS Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes. CONCLUSIONS Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement. Declaration of interest None.
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Affiliation(s)
- Rebecca Pedley
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Room 6.306 Jean McFarlane Building,
Oxford Road, Manchester, M13
9PL
| | - Caitlin McWilliams
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Karina Lovell
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Helen Brooks
- Department of Psychological Sciences,
Institute of Psychology, Health and Society,
University of Liverpool, Liverpool,
L69 3BX
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Richard J. Drake
- Division of Psychology and Mental Health,
School of Health Sciences, Faculty of
Biology, Medicine and Health, The University
of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Barnaby Rumbold
- Millbrook Independent Hospital,
Wythenshawe, Manchester, M23
2RX
| | - Vicky Bell
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Penny Bee
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
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Katsikitis M, Lane BR, Ozols I, Statham D. Consumer and carer perspectives in the development of a mental health research, treatment and teaching facility: A thematic analysis. J Psychiatr Ment Health Nurs 2017; 24:534-544. [PMID: 28449291 DOI: 10.1111/jpm.12394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 01/29/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Around the world, recovery has become a focus in mental health policy. The participation of people accessing mental health services (consumers) and carers of such individuals in decision-making related to services forms part of this recovery orientation and studies suggest positive outcomes following such participation. However, little is known about consumer and carer desires at the earliest stages of development of new services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Consumers and carers desire changes to how mental health services are provided. Many factors affect consumer and carer experiences, including language use, physical design of spaces, accessibility, consideration of individual needs, practical help and how well care is continued from hospital to community settings. Carers may feel sidelined in treatment and be distressed as a result. They wish to be respected and involved in recovery. Consumers and carers wish for focus on broader health, with care taken to address physical health, psychological needs, social needs and treatment of the whole person rather than just an illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Consumers and carers desire partnership with professionals in recovery. Tokenistic participation should be avoided. Flexibility in how services are provided and less formality may help engage consumers and carers. Specifically, professionals may help by linking consumers and carers to services that address practical needs. Professionals should communicate with carers to draw on their expertise about the individual accessing the mental health service and help carers understand how they can assist the individual's recovery. ABSTRACT Introduction Recovery-oriented mental health policies recognize consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. Aim This study sought consumer and carer perspectives addressing the establishment of a mental health research, treatment and teaching facility in their region. Methods Two 2-hr focus groups were conducted, with separate groups held for mental health consumers (n = 9) and carers (n = 9), respectively. Discussions pertained to mental health literacy, gaps in current services, desires for an ideal facility (in terms of physical design and services offered) and what would help in recovery. Results Inductive thematic analysis was used to generate three themes: care outside of consultations, carer involvement in recovery and holistic approaches to mental health care. Consumers desired a facility that could cater to individual needs. Carers felt excluded in recovery and unable to provide effective support. Both groups preferred holistic approaches to mental health, expressing ambivalence towards medication and hospitalization. Discussion Consumers and carers have many needs that conventional practices may not meet. Implications for practice They have clear desires for equal partnership in recovery and for transformation of conventional treatment methods.
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Affiliation(s)
- M Katsikitis
- School of Social Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - B R Lane
- School of Social Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - I Ozols
- Mental Health at Work, Melbourne, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - D Statham
- School of Social Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
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Simmons MB, Elmes A, McKenzie JE, Trevena L, Hetrick SE. Right choice, right time: Evaluation of an online decision aid for youth depression. Health Expect 2017; 20:714-723. [PMID: 27748004 PMCID: PMC5513008 DOI: 10.1111/hex.12510] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Appropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this. OBJECTIVES The main objective of this study was to evaluate an online decision aid for youth depression. DESIGN An uncontrolled cohort study with pre-decision, immediately post-decision and follow-up measurements. SETTING AND PARTICIPANTS Young people (n=66) aged 12-25 years with mild, mild-moderate or moderate-severe depression were recruited from two enhanced primary care services. INTERVENTION Online decision aid with evidence communication, preference elicitation and decision support components. MAIN OUTCOME MEASURES The main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow-up. RESULTS After using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3-22.9 points lower) on the Decisional Conflict Scale (range 0-100)) and felt involved and satisfied with their decision. At follow-up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3-4.0 points lower) on the Patient Health Questionnaire nine-item scale (range 0-27)) and were adherent to 88% (95% CI: 82%-94%) of treatment courses. DISCUSSION AND CONCLUSIONS A decision aid for youth depression can help ensure evidence-based, client-centred care, promoting collaboration in this often difficult to engage population.
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Affiliation(s)
- Magenta B. Simmons
- OrygenThe National Centre of Excellence in Youth Mental Health
- Centre for Youth Mental HealthThe University of Melbourne
| | - Aurora Elmes
- OrygenThe National Centre of Excellence in Youth Mental Health
- Centre for Youth Mental HealthThe University of Melbourne
| | - Joanne E. McKenzie
- School of Public Health and Preventive MedicineMonash UniversityClaytonVic.Australia
| | - Lyndal Trevena
- School of Public HealthThe University of SydneySydneyNSWAustralia
| | - Sarah E. Hetrick
- OrygenThe National Centre of Excellence in Youth Mental Health
- Centre for Youth Mental HealthThe University of Melbourne
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Drisko J. Active Collaboration with Clients: An Underemphasized but Vital Part of Evidence-Based Practice. SOCIAL WORK 2017; 62:114-121. [PMID: 28339592 DOI: 10.1093/sw/swx003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
Evidence-based practice (EBP) is a widely recognized concept in contemporary social work practice. However, recent studies have shown that social workers do not understand EBP correctly. Standardized administrative approaches to implementing EBP have led to confusion about its core practice decision-making process. This collaborative process is the heart of EBP in direct social work practice. This article explores the EBP process and addresses a vital but often underemphasized step of EBP: active collaboration with the client in decision making. Active collaboration with the client is shown to be important in that it (a) is consistent with social work's professional values and ethics, (b) is consistent with patient-centered health care in the Patient Protection and Affordable Care Act and contemporary health care approaches, (c) is consistent with culturally competent practice, and (d) has empirical support for its beneficial impact. Correctly and fully understanding EBP in direct practice is important to improving social work practice and improving client outcomes.
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Affiliation(s)
- James Drisko
- James Drisko, PhD, MSW, is professor, School for Social Work, Smith College, 23 West Street, Northampton, MA 01063; e-mail:
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An SY, Kim GH, Kim JY. Effectiveness of Shared Decision-Making Training Program in People With Schizophrenia in South Korea. Perspect Psychiatr Care 2017; 53:111-118. [PMID: 26601913 DOI: 10.1111/ppc.12144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the effects of shared decision-making (SDM) training program on self-esteem, problem-solving ability, and quality of life in people with schizophrenia. DESIGN AND METHODS A quasi-experiment with a nonequivalent control group pre-posttest design was conducted. The self-esteem scale, the problem-solving ability scale, and the WHOQOL Scale were used. FINDINGS The SDM training program was effective in improving their self-esteem, problem-solving ability, and quality of life in people with schizophrenia. PRACTICE IMPLICATIONS The SDM training program can be used in various mental health fields such as hospitals, mental health centers, and rehabilitation facilities.
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Affiliation(s)
- Se Youn An
- Yong-in Mental Hospital, Yongin-si, GyongGi-do, Korea
| | | | - Ji Young Kim
- College of Nursing, Chonbuk Research Institute of Nursing Science, Chonbuk National University, Jeonju-si, Jeollabuk-do, Korea
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Metz MJ, Elfeddali I, Krol DGH, Veerbeek MA, de Beurs E, Beekman ATF, van der Feltz-Cornelis CM. A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial. BMC Psychiatry 2017; 17:86. [PMID: 28270129 PMCID: PMC5341197 DOI: 10.1186/s12888-017-1247-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/24/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Enhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients' and clinicians' behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes. METHODS This article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake. DISCUSSION This study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment. TRIAL REGISTRATION Trial registration: Dutch Trial Register NTR5677 . Registered 17th January 2016.
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Affiliation(s)
- Margot J. Metz
- 0000 0004 1754 9227grid.12380.38EMGO Institute for Health and Care Research (EMGO+), VU University, Amsterdam, The Netherlands ,GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands
| | - Iman Elfeddali
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands ,0000 0001 0481 6099grid.5012.6School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands ,0000 0001 0943 3265grid.12295.3dTRANZO Department, Tilburg University, Tilburg, The Netherlands
| | - David G. H. Krol
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands
| | - Marjolein A. Veerbeek
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction (Trimbos Institute), P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - Edwin de Beurs
- 0000 0001 2312 1970grid.5132.5Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands ,Foundation Benchmark Mental Health Care, Stichting Benchmark GGZ, Rembrandtlaan 46, 3723 BK Bilthoven, The Netherlands
| | - Aartjan T. F. Beekman
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest, Mental Health Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Christina M. van der Feltz-Cornelis
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands ,0000 0001 0943 3265grid.12295.3dTRANZO Department, Tilburg University, Tilburg, The Netherlands
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Training patients with schizophrenia to share decisions with their psychiatrists: a randomized-controlled trial. Soc Psychiatry Psychiatr Epidemiol 2017; 52:175-182. [PMID: 28040825 DOI: 10.1007/s00127-016-1327-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients' communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence. METHODS Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient-doctor interaction such as question asking or giving feedback. RESULTS N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients' participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists' estimate) their behavior in psychiatric consultations. CONCLUSIONS While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients' active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.
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Fisher A, Manicavasagar V, Sharpe L, Laidsaar-Powell R, Juraskova I. A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder. J Ment Health 2017; 27:66-79. [PMID: 28084845 DOI: 10.1080/09638237.2016.1276533] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. AIM To explore patient and family perspectives of treatment decision-making in BPII. METHOD Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. RESULTS Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. CONCLUSIONS This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. DECLARATION OF INTEREST This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.
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Affiliation(s)
- Alana Fisher
- a School of Psychology.,b Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney , New South Wales , Australia
| | - Vijaya Manicavasagar
- c School of Psychiatry , and.,d Black Dog Institute, University of New South Wales , New South Wales , Australia
| | | | - Rebekah Laidsaar-Powell
- a School of Psychology.,b Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney , New South Wales , Australia
| | - Ilona Juraskova
- a School of Psychology.,b Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney , New South Wales , Australia
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Keating D, McWilliams S, Schneider I, Hynes C, Cousins G, Strawbridge J, Clarke M. Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode. BMJ Open 2017; 7:e013881. [PMID: 28062471 PMCID: PMC5223704 DOI: 10.1136/bmjopen-2016-013881] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia. METHODS A multidisciplinary group identified key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia. The MEDLINE and EMBASE databases, websites of professional organisations and international guideline repositories, were searched for CPGs that met the inclusion criteria. The AGREE II instrument was applied by three raters and data were extracted from the guidelines in relation to the key health questions. RESULTS In total, 3299 records were screened. 10 guidelines met the inclusion criteria. 3 guidelines scored well across all domains. Recommendations varied in specificity. Side effect concerns, rather than comparative efficacy benefits, were a key consideration in antipsychotic choice. Antipsychotic medication is recommended for maintenance of remission following a first episode of schizophrenia but there is a paucity of evidence to guide duration of treatment. Clozapine is universally regarded as the medication of choice for treatment resistance. There is less evidence to guide care for those who do not respond to clozapine. CONCLUSIONS An individual's experience of using antipsychotic medication for the initial treatment of first-episode schizophrenia may have implications for future engagement, adherence and outcome. While guidelines of good quality exist to assist in medicines optimisation, the evidence base required to answer key health questions relevant to the pharmacological treatment of first-episode schizophrenia is limited.
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Affiliation(s)
- Dolores Keating
- Pharmacy Department, Saint John of God Hospital, Co Dublin, Ireland
| | | | - Ian Schneider
- Department of Old Age Psychiatry, Saint James's Hospital, Dublin, Ireland
| | - Caroline Hynes
- Pharmacy Department, Saint John of God Hospital, Co Dublin, Ireland
| | - Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Judith Strawbridge
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Blackrock, Co Dublin, Ireland
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Degli Stefani M, Biasutti M. Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study. Front Psychol 2016; 7:1518. [PMID: 27774073 PMCID: PMC5054002 DOI: 10.3389/fpsyg.2016.01518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/20/2016] [Indexed: 12/30/2022] Open
Abstract
Objective: Framed in the patients’ engagement perspective, the current study aims to determine the effects of group music therapy in addition to drug care in comparison with drug care in addition to other non-expressive group activities in the treatment of psychiatric outpatients. Method: Participants (n = 27) with ICD-10 diagnoses of F20 (schizophrenia), F25 (schizoaffective disorders), F31 (bipolar affective disorder), F32 (depressive episode), and F60 (specific personality disorders) were randomized to receive group music therapy plus standard care (48 weekly sessions of 2 h) or standard care only. The clinical measures included dosages of neuroleptics, benzodiazepines, mood stabilizers, and antidepressants. Results: The participants who received group music therapy demonstrated greater improvement in drug dosage with respect to neuroleptics than those who did not receive group music therapy. Antidepressants had an increment for both groups that was significant only for the control group. Benzodiazepines and mood stabilizers did not show any significant change in either group. Conclusion: Group music therapy combined with standard drug care was effective for controlling neuroleptic drug dosages in adult psychiatric outpatients who received group music therapy. We discussed the likely applications of group music therapy in psychiatry and the possible contribution of music therapy in improving the psychopathological condition of adult outpatients. In addition, the implications for the patient-centered perspective were also discussed.
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Affiliation(s)
- Mario Degli Stefani
- Department of Mental Health, 2° Servizio Psichiatrico Ulss 16 Padova, Padova Italy
| | - Michele Biasutti
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova Italy
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Morant N, Kaminskiy E, Ramon S. Shared decision making for psychiatric medication management: beyond the micro-social. Health Expect 2016; 19:1002-14. [PMID: 26260361 PMCID: PMC5053275 DOI: 10.1111/hex.12392] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. OBJECTIVES This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. CONCLUSION A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care.
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Affiliation(s)
| | - Emma Kaminskiy
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Shulamit Ramon
- Department of Education and Social Care, Anglia Ruskin University, Cambridge, UK
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Menear M, Gervais M, Careau E, Chouinard MC, Cloutier G, Delorme A, Dogba MJ, Dugas M, Gagnon MP, Gilbert M, Harvey D, Houle J, Kates N, Knowles S, Martin N, Nease D, Pluye P, Samson E, Zomahoun HTV, Légaré F. Strategies and impacts of patient and family engagement in collaborative mental healthcare: protocol for a systematic and realist review. BMJ Open 2016; 6:e012949. [PMID: 27678546 PMCID: PMC5051434 DOI: 10.1136/bmjopen-2016-012949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Collaborative mental healthcare (CMHC) has garnered worldwide interest as an effective, team-based approach to managing common mental disorders in primary care. However, questions remain about how CMHC works and why it works in some circumstances but not others. In this study, we will review the evidence on one understudied but potentially critical component of CMHC, namely the engagement of patients and families in care. Our aims are to describe the strategies used to engage people with depression or anxiety disorders and their families in CMHC and understand how these strategies work, for whom and in what circumstances. METHODS AND ANALYSIS We are conducting a review with systematic and realist review components. Review part 1 seeks to identify and describe the patient and family engagement strategies featured in CMHC interventions based on systematic searches and descriptive analysis of these interventions. We will use a 2012 Cochrane review of CMHC as a starting point and perform new searches in multiple databases and trial registers to retrieve more recent CMHC intervention studies. In review part 2, we will build and refine programme theories for each of these engagement strategies. Initial theory building will proceed iteratively through content expert consultations, electronic searches for theoretical literature and review team brainstorming sessions. Cluster searches will then retrieve additional data on contexts, mechanisms and outcomes associated with engagement strategies, and pairs of review authors will analyse and synthesise the evidence and adjust initial programme theories. ETHICS AND DISSEMINATION Our review follows a participatory approach with multiple knowledge users and persons with lived experience of mental illness. These partners will help us develop and tailor project outputs, including publications, policy briefs, training materials and guidance on how to make CMHC more patient-centred and family-centred. PROSPERO REGISTRATION NUMBER CRD42015025522.
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Affiliation(s)
- Matthew Menear
- CHU de Québec Research Centre, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
| | | | - Emmanuelle Careau
- Department of Rehabilitation, Laval University, Quebec, Quebec, Canada
| | | | - Guylaine Cloutier
- Association québecoise pour la réadaptation psychosociale, Quebec, Quebec, Canada
| | - André Delorme
- Quebec Ministry of Health and Social Services, Quebec, Quebec, Canada
| | - Maman Joyce Dogba
- CHU de Québec Research Centre, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
| | - Michèle Dugas
- CHU de Québec Research Centre, Quebec, Quebec, Canada
| | | | - Michel Gilbert
- National Centre for Excellence in Mental Health, Montreal, Quebec, Canada
| | - Diane Harvey
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sara Knowles
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Neasa Martin
- Neasa Martin and Associates, Toronto, Ontario, Canada
| | - Donald Nease
- Department of Family Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Esther Samson
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | | | - France Légaré
- CHU de Québec Research Centre, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Quebec, Canada
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Liebherz S, Härter M, Dirmaier J, Tlach L. Information and Decision-Making Needs Among People with Anxiety Disorders: Results of an Online Survey. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:531-9. [PMID: 25663124 DOI: 10.1007/s40271-015-0116-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND People with anxiety disorders are faced with treatment decisions considerably affecting their life. Patient decision aids are aimed at enabling patients to deliberate treatment options based on individual values and to participate in medical decisions. OBJECTIVE This is the first study to determine patients' information and decision-making needs as a pre-requisite for the development of patient decision aids for anxiety disorders. METHODS An online cross-sectional survey was conducted between January and April 2013 on the e-health portal http://www.psychenet.de by using a self-administered questionnaire with items on internet use, online health information needs, role in decision making and important treatment decisions. Descriptive and inferential statistical as well as qualitative data analyses were performed. RESULTS A total of 60 people with anxiety disorders with a mean age of 33.3 years (SD 10.5) participated in the survey. The most prevalent reasons for online health information search were the need for general information on anxiety disorders, the search for a physician or psychiatrist and the insufficiency of information given by the healthcare provider. Respondents experienced less shared and more autonomous decisions than they preferred. They assessed decisions on psychotherapy, medication, and treatment setting (inpatient or outpatient) as the most difficult decisions. CONCLUSION Our results confirm the importance of offering patient decision aids for people with anxiety disorders that encourage patients to participate in decision making by providing information about the pros and cons of evidence-based treatment options.
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Affiliation(s)
- Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, W26, 20246, Hamburg, Germany.
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, W26, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, W26, 20246, Hamburg, Germany
| | - Lisa Tlach
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, W26, 20246, Hamburg, Germany
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50
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Alvarez K, Wang Y, Alegria M, Ault-Brutus A, Ramanayake N, Yeh YH, Jeffries JR, Shrout PE. Psychometrics of shared decision making and communication as patient centered measures for two language groups. Psychol Assess 2016; 28:1074-86. [PMID: 27537002 PMCID: PMC5431590 DOI: 10.1037/pas0000344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | | | - Natasha Ramanayake
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Yi-Hui Yeh
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
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