A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers

Trends, challenges, and priorities for shared decision making in mental health: The first umbrella review

BACKGROUND

Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental health.

AIMS

(1) Provide the first systematic analysis of global development trends and challenges of SDM research; (2) clarify the meaning, role, and measurement of SDM in mental health; (3) create a theoretical framework for key effective SDM components to guide future development and implementation of SDM interventions.

METHODS

A comprehensive search strategy was conducted in CINAHL, PubMed, Scopus, MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, and PsycInfo. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measurement tools, comparisons, and outcomes.

RESULTS

10 systematic reviews of SDM in mental health were included with 100 nested studies spanning from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions include treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported.

CONCLUSIONS

The current landscape of SDM in mental health is overwhelmingly disconnected from the needs and experiences of potential end-users; clients, clinicians, and family members. Most SDM interventions and tools were adapted from physical health and are mainly geared to psychopharmacological decision-making. The SDM in Mental Health Framework (SDM-MH), developed here, expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes of SDM in mental health to reduce heterogeneity across studies.

Shared decision-making interventions for people with mental health conditions

BACKGROUND

One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society.  International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision.  This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010.

OBJECTIVES

To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes.

SEARCH METHODS

We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies.  We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification.

SELECTION CRITERIA

Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria).

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents.  Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported.

AUTHORS' CONCLUSIONS

This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations.  Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.

Randomized Controlled Trials of Digital Mental Health Interventions on Patients with Schizophrenia Spectrum Disorder: A Systematic Review

Background: This systematic review aimed to examine the study protocol of Digital Mental Health Interventions (DMHIs) and to review the effect of DMHIs among patients with Schizophrenia Spectrum Disorder (SSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using PubMed, CINAHL, Embase, and PsycINFO electronic databases to identify randomized clinical trials without any limit on the publication year. Overall, 18 studies were selected and evaluated for the quality assessment utilizing the Risk of Bias 2 tool of Cochranes' Collaboration. In the quality assessment, four studies evaluated as overall high risk of bias were excluded from the selection, and the final 14 studies were chosen. Results: No DMHIs were provided for acute schizophrenia-related symptoms, and there were some studies related to schizophrenia-related symptoms (26.4%). Some studies for improving cognitive function (42.9%) were reported, and there was a significant effect when interventions that were proven to be effective when implemented in a face-to-face manner were delivered using various online devices and sensory stimuli. Nearly half of the studies reported intervention frequency and time (57.1%), and those with unclear reports relied either on a mobile app or telemedicine and were designed to self-pace the frequency and speed of the intervention. Conclusion: Based on our findings, it will be possible to understand the characteristics of DMHIs, without physical contact, for only SSD patients, providing a basis for digital mental health services.

Digital Shared Decision-Making Interventions in Mental Healthcare: A Systematic Review and Meta-Analysis

Background: Shared decision-making (SDM) in mental healthcare has received increased attention as a process to reinforce person-centered care. With the rapid development of digital health technology, researchers investigate how digital interventions may be utilized to support SDM. Despite the promise of digital interventions to support SDM, the effect of these in mental healthcare has not been evaluated before. Thus, this paper aims to assess the effect of SDM interventions complimented by digital technology in mental healthcare. Objective: The objective of this review was to systematically examine the effectiveness of digital SDM interventions on patient outcomes as investigated in randomized trials. Methods: We performed a systematic review and meta-analysis of randomized controlled trials on digital SDM interventions for people with a mental health condition. We searched for relevant studies in MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. The search strategy included terms relating to SDM, digital systems, mental health conditions, and study type. The primary outcome was patient activation or indices of the same (e.g., empowerment and self-efficacy), adherence to treatment, hospital admissions, severity of symptoms, and level of functioning. Secondary outcomes were satisfaction, decisional conflict, working alliance, usage, and adherence of medicine; and adverse events were defined as harms or side effects. Results: Sixteen studies met the inclusion criteria with outcome data from 2,400 participants. Digital SDM interventions had a moderate positive effect as compared with a control condition on patient activation [standardized mean difference (SMD) = 0.56, CI: 0.10, 1.01, p = 0.02], a small effect on general symptoms (SMD = -0.17, CI: -0.31, -0.03, p = 0.02), and working alliance (SMD = 0.21, CI: 0.02, 0.41, p = 0.03) and for improving decisional conflict (SMD = -0.37, CI: -0.70, -0.05, p = 0.02). No effect was found on self-efficacy, other types of mental health symptoms, adverse events, or patient satisfaction. A total of 39 outcomes were narratively synthesized with results either favoring the intervention group or showing no significant differences between groups. Studies were generally assessed to have unclear or high risk of bias, and outcomes had a Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of low- or very low-quality evidence. Conclusions: Digital interventions to support SDM may be a promising tool in mental healthcare; but with the limited quality of research, we have little confidence in the estimates of effect. More quality research is needed to further assess the effectiveness of digital means to support SDM but also to determine which digital intervention features are most effective to support SDM. Systematic Review Registration: PROSPERO, identifier CRD42020148132.

A pilot digital intervention targeting loneliness in young people with psychosis

PURPOSE

Loneliness has been identified as a significant challenge for people with psychosis. Interventions targeting loneliness are lacking but adopting a positive psychology approach may reduce loneliness, promote well-being, and support meaningful social interactions. Together with youth mental health consumers, we developed a digital smartphone application (app) called +Connect, which delivers positive psychology content daily for 6 weeks.

MATERIALS AND METHODS

Twelve participants diagnosed with a psychotic disorder were recruited from early psychosis services. Loneliness was assessed pre-intervention, post-intervention, and 3-month post-intervention. Acceptability, feasibility, and usability were measured post-intervention, including a semi-structured interview on the user's experience of +Connect.

RESULTS

We found evidence for the feasibility of +Connect. All but two participants completed the +Connect program, completing 95% (40.10 out of 42 days) of the program. Furthermore, 66.67% (8 out of the 12 participants) remained engaged with the program 3-months post-intervention. Our data indicates preliminary evidence that +Connect may reduce loneliness, with scores from pre-intervention (M = 50.00, SD = 8.47) to post-intervention (M = 48.10, SD = 10.38) and 3-months post-intervention (M = 42.89, SD = 7.04). We found that positive reinforcement of in-game rewards and evidence of positive mood changes added to the feasibility of the app. Regarding acceptability, while 10% (1/10 participants) reported not finding +Connect useful or enjoyable, 90% of participants agreed that +Connect helped them to increase their social confidence, enjoy life, look forward to being with other people, and feel more connected with others. Participant interviews supported these results, with participants highlighting the app's strengths in providing useful information, stimulating self-reflection, fostering positive affect, and encouraging transfer of skills into their social interactions.

DISCUSSION

While preliminary findings indicated that +Connect yielded high levels of acceptability and feasibility, it is important to consider that we recruited a small and selected sample of lonely young people. Further iterations of this proof of concept app, which can incorporate participant feedback such preferences for increased personalisation, in-app feedback, and gamification, may allow an opportunity to test an improved version in the future.

Indigeneity, diversity, and equity in Internet interventions: Could ISRII contribute to making health care a universal human right?

This article is a partially revised version of a keynote address presented at the 10th Scientific Meeting of the International Society for Research on Internet Interventions (ISRII) in Auckland, New Zealand. It addresses six points: 1) the meanings of indigeneity, diversity, and equity, 2) the strong emotional reactions elicited by the inequities experienced by indigenous groups throughout the world, 3) the aspirations of members of ISRII in terms of what we would like our field to accomplish to address these inequities, 4) the United Nations goal of making health care a universal human right, 5) the difficulties encountered by other health sciences in attempting to include diverse populations into major studies, and 6) ways in which the Internet interventions and digital health field could include indigeneity, diversity, and equity in our work, and by doing so, contribute to the United Nations goal of making health care a universal human right. The authors suggest that providing access to health care to all people, no matter where they are on the socioeconomic continuum, is a key strategy to pursue. The field of Internet interventions could contribute by creating digital apothecaries that would develop, evaluate, and disseminate evidence-based Massive Open Online Interventions to anyone in the world who needs them.

Feasibility, Acceptability, and Preliminary Impacts of Web-Based Patient Education on Patients With Schizophrenia Spectrum Disorder: Quasi-Experimental Cluster Study

BACKGROUND

Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders.

OBJECTIVE

This study aimed to test the feasibility and acceptability of a Web-based patient education intervention using a quasi-experimental cluster design to report feedback on patient education sessions and the website used and to report preliminary evidence of the intervention's impact on patients with schizophrenia spectrum disorder.

METHODS

A single-blind, parallel, quasi-experimental cluster study over a 6-month period comparing Web-based education (n=33) with a nonequivalent control group (treatment as usual, n=24) for people with schizophrenia spectrum disorder was conducted. Participants (N=57) were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants' commitment (refusal rate, dropout rate) to the study. Acceptability was assessed as participants' commitment to the intervention. Patient education sessions and website feedback were assessed by the patients and health care professionals. The preliminary impact of the sessions on patients' self-efficacy, self-esteem, illness cognition, and knowledge level was measured at baseline and follow-ups (8 weeks, 6 months) with self-rated questionnaires.

RESULTS

The refusal rate among patients was high with no statistically significant difference (69% [74/107] in the intervention group, 76% [76/100] in the control group; P=.21). The same result was found for the dropout rates (48% [16/33] vs 58% [14/24]; P=.46). The acceptability of the intervention was good; 31 participants out of 33 (94%) completed all five sessions. Feedback on the intervention was mainly positive; three out of four subscales of session were rated above the midpoint of 4.0. Feedback on the website was also positive, with a grade of good for content (69%, 20/29 patients; 75%, 21/28 professionals), layout (62%, 18/29 patients; 61%, 17/28 professionals), and usability (62%, 18/29 patients; and 68%, 19/28 professionals). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (baseline mean 26.12, SD 5.64 vs 6-month mean 29.24, SD 6.05; P=.003) and regarding knowledge level about schizophrenia (mean 11.39, SD 4.65 vs 6-month mean 15.06, SD 5.26; P=.002), and lower scores in the subscale of helplessness in illness cognition (mean 2.26, SD 0.96 vs 6-month mean 1.85, SD 0.59; P=.03). Differences from the control group were not significant. No differences were found in patients' self-esteem or other subscales in illness cognition.

CONCLUSIONS

The patients were reluctant to participate in the study and tended to drop out before the follow-ups. Once they had participated, their acceptance of the intervention was high. A more effective recruitment strategy and monitoring method will be needed in future studies. To assess the impact of the intervention, a more rigorous study design with an adequately powered sample size will be used in cooperation with outpatient mental health services.

The Momentum trial: the efficacy of using a smartphone application to promote patient activation and support shared decision making in people with a diagnosis of schizophrenia in outpatient treatment settings: a randomized controlled single-blind trial

BACKGROUND

Shared decision making (SDM) is often defined as an interactive process that ensures that both patient and practitioner are actively involved in the treatment and that they share all relevant information to arrive at a mental health decision. Previous SDM interventions have found improvements in outcomes such as personal recovery, higher perceived involvement in treatment decisions and knowledge about one's disease. Still, SDM occurs less frequently in mental health care than in primary care. Electronic aids developed to support patient activation and SDM could be a promising mean to engage patients in their mental healthcare. The aim of this trial is to investigate the effects of using a smartphone app to promote patient activation and support SDM for people with schizophrenia-spectrum disorders in an outpatient treatment setting.

METHODS

This randomised controlled trial will allocate participants to one of two groups: (1) Intervention group: smartphone app and TAU (treatment as usual) or (2) Control group: TAU without the smartphone app. A total sample size of 260 people with a diagnosis of schizophrenia, schizotypal or delusional disorder will be recruited from five OPUS teams (a specialized early intervention program) in Denmark between 2019 and 2020. The intervention will last for 6 months with data collection at baseline, and at 3 and 6 months. Primary outcome will be self-perceived patient activation. Secondary outcomes will be feeling of being prepared for SDM; self-efficacy; working alliance; treatment satisfaction; positive and negative symptoms; level of functioning; hope; and perceived efficacy in patient-provider interaction. Patients' and health providers' preferences in clinical decision making will be assessed. Patients' usage and perceived usefulness of the app will be explored.

DISCUSSION

This study will investigate the efficacy of using the smartphone app to support people with severe mental illness in engaging in their own healthcare management. The study may provide evidence to the idea that linking client and practitioner in digital solutions can have advantages in facilitating SDM in mental health. The trial will provide new knowledge of whether a digital healthcare solution can improve patient activation and support SDM for people with severe mental illness.

TRIAL REGISTRATION

ClinicalTrials.gov number: NCT03554655 Registered on: June 13, 2018.

Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial

Background: Preoperative advance care planning (ACP) may benefit patients undergoing major surgery. Objective: To evaluate feasibility, safety, and early effectiveness of video-based ACP in a surgical population. Design: Randomized controlled trial with two study arms. Setting: Single, academic, inner-city tertiary care hospital. Subjects: Patients undergoing major cancer surgery were recruited from nine surgical clinics. Of 106 consecutive potential participants, 103 were eligible and 92 enrolled. Interventions: In the intervention arm, patients viewed an ACP video developed by patients, surgeons, palliative care clinicians, and other stakeholders. In the control arm, patients viewed an informational video about the hospital's surgical program. Measurements: Primary Outcomes-ACP content and patient-centeredness in patient-surgeon preoperative conversation. Secondary outcomes-patient Hospital Anxiety and Depression Scale (HADS) score; patient goals of care; patient and surgeon satisfaction; video helpfulness; and medical decision maker designation. Results: Ninety-two patients (target enrollment: 90) were enrolled. The ACP video was successfully integrated with no harm noted. Patient-centeredness was unchanged (incidence rate ratio [IRR] = 1.06, confidence interval [0.87-1.3], p = 0.545), although there were more ACP discussions in the intervention arm (23% intervention vs. 10% control, p = 0.18). While slightly underpowered, study results did not signal that further enrollment would have yielded statistical significance. There were no differences in secondary outcomes other than the intervention video was more helpful (p = 0.007). Conclusions: The ACP video was successfully integrated into surgical care without harm and was thought to be helpful, although video content did not significantly change the ACP content or patient-surgeon communication. Future studies could increase the ACP dose through modifying video content and/or who presents ACP. Trial Registration: clinicaltrials.gov Identifier NCT02489799.

A Pilot Digital Intervention Targeting Loneliness in Youth Mental Health

Background: Loneliness is an emerging issue for young people, but yet many interventions to address loneliness in this group focus on providing social opportunities. While these sorts of interventions may appear to increase social connections, loneliness is more related to quality rather than quantity of social relationships. Thus, interventions addressing loneliness should focus on maximizing the quality of current relationships. Together with youth consumers both with mental ill health and those without, we developed a digital smartphone application (app) called +Connect. The 6-week program delivers positive psychology content designed to improve relationship quality. We tested the acceptability, feasibility, and safety of the program in lonely young people with or without a mental health diagnosis of social anxiety disorder. We used a mixed method study design to triangulate pilot quantitative and qualitative data in young people with and without social anxiety disorder (SAD). Method: Nine participants with a diagnosis of social anxiety disorder (M _age = 21.00; SD = 1.41) and 11 participants with no mental health conditions (M _age = 20.36; SD = 2.16) completed the +Connect digital intervention. Results: Those with social anxiety disorder reported less acceptable ratings on outcomes. Feasibility ratings, measured by uptake and app completion, met a priori threshold criteria in both groups. Those with social anxiety disorder yielded more attrition, with almost double the attrition rate compared with those without the disorder. There were no safety issues elicited during the pilot study. In terms of outcomes, exploratory analyses indicated that the app itself is likely to be beneficial rather than cause harm. Our qualitative data indicated both groups reported no negative outcomes and noted that positive outcomes were driven by three processes: reflection, learning, and real-life application. Further exploratory data on usability indicated room for improvement in terms of giving more support for different components of the app (i.e., challenges). Conclusion: The pilot findings of this proof-of-concept app indicates some promise in terms of a second iterative version of +Connect.

Modeling the adoption of personal health record (PHR) among individual: the effect of health-care technology self-efficacy and gender concern

BACKGROUND

With the development of information technology (IT) and medical technology, medical information has been developed from traditional paper-based records into up-to-date medical information exchange system called personal health record (PHR). Empowering PHR provides health awareness and intention for health promotion.

OBJECTIVE

The purpose of this study was to present a research framework to examine individuals' intention to PHR use.

METHODS

This cross-sectional study used the questionnaire to collect data from the individual in Taiwan. Individual's intention to use PHR has been examined by a framework based on extended technology acceptance model (TAM), with gender and health-care technology self-efficacy (HTSE) as external variables. Additionally, gender differences were explored in perceptions and relationships among factors influencing an individual's intention to PHR use. The research framework was evaluated by structural equation modeling (SEM) and represented by Analysis of a Moment Structures (AMOS).

RESULTS

A total of 234 valid responses were used for analysis. The results suggest that the extended TAM model explains 40.6% of the variance of intention to PHR use (R2 = 0.406). The findings also supported that perceived usefulness, perceived ease of use, and attitude toward using PHR significantly influenced individual's intention to PHR use. Additionally, results also indicated that women were more strongly influenced by perceptions of HTSE.

CONCLUSIONS

The extended TAM model contributes reasonable explanation for interprets and anticipates of individuals' intention to use and adopt PHR. Moreover, the results have provided support for HTSE and gender as significant variables in TAM. However, the study identified three relevant factors directly and one factor indirectly influencing on individuals' intention to PHR use. Thus, health care providers and hospital authorities must take these factors and gender difference into consideration in the development and validation of the theories regarding the acceptance of PHR. Based on the findings, the theoretical and practical implications are discussed.

Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns

OBJECTIVE

The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample.

METHODS

Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns.

RESULTS

The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction.

CONCLUSIONS

Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation.

PRACTICE IMPLICATIONS

Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.

Family companions' involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction

OBJECTIVE

To examine the association between family companion presence during pre-surgical visits to discuss major cancer surgery and patient-provider communication and satisfaction.

METHODS

Secondary analysis of 61 pre-surgical visit recordings with eight surgical oncologists at an academic tertiary care hospital using the Roter Interaction Analysis System (RIAS). Surgeons, patients, and companions completed post-visit satisfaction questionnaires. Poisson and logistic regression models assessed differences in communication and satisfaction when companions were present vs. absent.

RESULTS

There were 46 visits (75%) in which companions were present, and 15 (25%) in which companions were absent. Companion communication was largely emotional and facilitative, as measured by RIAS. Companion presence was associated with more surgeon talk (IRR 1.29, p = 0.006), and medical information-giving (IRR 1.41, p = 0.001). Companion presence was associated with less disclosure of lifestyle/psychosocial topics by patients (IRR 0.55, p = 0.037). In adjusted analyses, companions' presence was associated with lower levels of patient-centeredness (IRR 0.77, p 0.004). There were no differences in patient or surgeon satisfaction based on companion presence.

CONCLUSION

Companions' presence during pre-surgical visits was associated with patient-surgeon communication but was not associated with patient or surgeon satisfaction.

PRACTICE IMPLICATIONS

Future work is needed to develop interventions to enhance patient-companion-provider interactions in this setting.

An advance care plan decision support video before major surgery: a patient- and family-centred approach

OBJECTIVE

Video-based advanc care planning (ACP) tools have been studied in varied medical contexts; however, none have been developed for patients undergoing major surgery. Using a patient- and family-centredness approach, our objective was to implement human-centred design (HCD) to develop an ACP decision support video for patients and their family members when preparing for major surgery.

DESIGN AND METHODS

The study investigators partnered with surgical patients and their family members, surgeons and other health professionals to design an ACP decision support video using key HCD principles. Adapting Maguire's HCD stages from computer science to the surgical context, while also incorporating Elwyn et al's specifications for patient-oriented decision support tool development, we used a six-stage HCD process to develop the video: (1) plan HCD process; (2) specify where video will be used; (3) specify user and organisational requirements; (4) produce and test prototypes; (5) carry out user-based assessment; (6) field test with end users.

RESULTS

Over 450 stakeholders were engaged in the development process contributing to setting objectives, applying for funding, providing feedback on the storyboard and iterations of the decision tool video. Throughout the HCD process, stakeholders' opinions were compiled and conflicting approaches negotiated resulting in a tool that addressed stakeholders' concerns.

CONCLUSIONS

Our patient- and family-centred approach using HCD facilitated discussion and the ability to elicit and balance sometimes competing viewpoints. The early engagement of users and stakeholders throughout the development process may help to ensure tools address the stated needs of these individuals.

TRIAL REGISTRATION NUMBER

NCT02489799.

Video-based mobile health interventions for people with schizophrenia: Bringing the "pocket therapist" to life

OBJECTIVE

To examine whether video-based mobile health (mHealth) interventions are feasible, acceptable, understandable, and engaging to people with schizophrenia.

METHOD

This study used a mixed-methods design. Ten individuals with schizophrenia spectrum disorders were recruited for a month-long trial in which they used FOCUS-Audio/Video (FOCUS-AV), a smartphone system that offers video and written intervention options. Participants completed posttrial measures and engaged in semistructured interviews.

FINDINGS

One participant dropped out. The remaining 9 participants used intervention videos successfully. Participants responded to 67% of system-delivered prompts to engage FOCUS-AV, and 52% of FOCUS-AV use was initiated by the users. On average, participants used interventions 6 days a week, 4 times daily. Participants used video functions an average of 28 times. They chose video over written interventions on 67% of the times they used on-demand functions but opted for written content 78% of the times they responded to prescheduled prompts. Clinician videos were rated as more personal, engaging, and helpful than written interventions. Video and written interventions were rated as equally usable and understandable. Written interventions were rated as more favorable in letting users proceed at their own pace. Similarly to what is seen in live therapy, the communication style and demeanor of clinicians depicted in intervention videos reportedly affected participants' experience with treatment.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Video-based mHealth may be a feasible, usable, acceptable, and highly engaging method for flexible delivery of interventions to people with schizophrenia using mobile technology. Producing intervention videos is more time-, labor-, and cost-intensive than generating written content, but participant feedback suggests that there may be added value in this approach. Additional research will determine whether video-based mHealth interventions lead to better, faster, or more sustainable clinical gains. (PsycINFO Database Record

Informed and patient-centered decision-making in the primary care visits of African Americans with depression

OBJECTIVE

We examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression.

METHODS

We performed a cross-sectional analysis of audiotaped clinical encounters and post-visit surveys of 76 patients and their clinicians. We used RIAS to characterize patient-centeredness of visit dialogue. IDM entailed discussion of 3 components: the nature of the decision, alternatives, and pros/cons. PCDM entailed discussion of: lifestyle/coping strategies, knowledge/beliefs, or treatment concerns. We examined the association of IDM and PCDM with visit duration, overall patient-centeredness, and patient/clinician interpersonal ratings.

RESULTS

Approximately one-quarter of medication and counseling decisions included essential IDM elements and 40% included at least one PCDM element. In high patient-centered visits, IDM was associated with patients feeling respected in counseling and liking clinicians in medication decisions. IDM was not related to clinician ratings. In low patient-centered visits, PCDM in counseling decisions was positively associated with patients feeling respected and clinicians respecting patients.

CONCLUSIONS

The associations between IDM and PCDM with interpersonal ratings was moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues.

PRACTICE IMPLICATIONS

Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making.

Communication skills training for mental health professionals working with people with severe mental illness

BACKGROUND

Research evidence suggests that both mental health professionals and people with severe mental health illness such as schizophrenia or schizoaffective disorder find it difficult to communicate with each other effectively about symptoms, treatments and their side effects so that they reach a shared understanding about diagnosis, prognosis and treatment. Effective use of communication skills in mental health interactions could be associated with increased patient satisfaction and adherence to treatment.

OBJECTIVES

To review the effectiveness of communication skills training for mental health professionals who work with people with severe mental illness.

SEARCH METHODS

We searched the Cochrane Schizophrenia Trials Register (latest search 17 February, 2016) which is compiled by systematic searches of major resources (including AMED, BIOSIS, CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records into the register.

SELECTION CRITERIA

All relevant randomised clinical trials (RCTs) that focused on communication skills training (CST) for mental health professionals who work with people with severe mental illness compared with those who received standard or no training. We sought a number of primary (patient adherence to treatment and attendance at scheduled appointments as well as mental health professionals' satisfaction with the training programme) and secondary outcomes (patients' global state, service use, mental state, patient satisfaction, social functioning, quality of life). RCTs where the unit of randomisation was by cluster (e.g. healthcare facility) were also eligible for inclusion. We included one trial that met our inclusion criteria and reported useable data.

DATA COLLECTION AND ANALYSIS

We independently selected studies, quality assessed them and extracted data. For binary outcomes, we planned to calculate standard estimates of the risk ratio (RR) and their 95% confidence intervals (CI) using a fixed-effect model. For continuous outcomes, we planned to estimate the mean difference (MD) between groups, or obtain the adjusted mean difference (aMD) where available for cluster-randomised trials. If heterogeneity had been identified, we would have explored this using a random-effects model. We used GRADE to create a 'Summary of findings' table and we assessed risk of bias for the one included study.

MAIN RESULTS

We included one pilot cluster-RCT that recruited a total of 21 psychiatrists and 97 patients. The psychiatrists were randomised to a training programme in communication skills, compared to a no specific training (NST) programme. The trial provided useable data for only one of our prestated outcomes of interest, patient satisfaction. The trial did not report global state but did report mental state and, as global state data were not available, we included these mental state data in the 'Summary of findings' table. There was high risk of bias from attrition because of substantial losses to follow-up and incomplete outcome data.Patient satisfaction was measured as satisfaction with treatment and 'experience of therapeutic relationship' at medium term (five months). Satisfaction with treatment was similar between the CST and NST group using the Client Satisfaction Questionnaire (CSQ-8) (1 RCT, n = 66/97*, aMD 1.77 95% CI - 0.13 to 3.68, low-quality evidence). When comparing patient experience of the therapeutic relationship using the STAR-P scale, participants in the CST group rated the therapeutic relationship more positively than participants in the NST group (1 RCT, n = 63/97, aMD 0.21 95% CI 0.01 to 0.41, low-quality evidence).Mental state scores on the Positive and Negative Syndrome Scale (PANSS) were similar between treatment groups for general symptoms (1 RCT, n = 59/97, aMD 4.48 95% CI -2.10 to 11.06, low-quality evidence), positive symptoms (1 RCT, n = 59/97, aMD -0.23, 95% CI -2.91 to 2.45, low-quality evidence) and negative symptoms (1 RCT, n = 59/97, aMD 3.42, 95%C CI -0.24 to 7.09, low-quality evidence).No data were available for adherence to treatment, service use or quality of life.* Of the total of 97 randomised participants, 66 provided data.

AUTHORS' CONCLUSIONS

The evidence available is from one pilot cluster-randomised controlled trial, it is not adequate enough to draw any robust conclusions. There were relatively few good quality data and the trial is too small to highlight differences in most outcome measures. Adding a CST programme appears to have a modest positive effect on patients' experiences of the therapeutic relationship. More high-quality research is needed in this area.

Utilising advance care planning videos to empower perioperative cancer patients and families: a study protocol of a randomised controlled trial

INTRODUCTION

Despite positive health outcomes associated with advance care planning (ACP), little research has investigated the impact of ACP in surgical populations. Our goal is to evaluate how an ACP intervention video impacts the patient centredness and ACP of the patient-surgeon conversation during the presurgical consent visit. We hypothesise that patients who view the intervention will engage in a more patient-centred communication with their surgeons compared with patients who view a control video.

METHODS AND ANALYSIS

Randomised controlled superiority trial of an ACP video with two study arms (intervention ACP video and control video) and four visits (baseline, presurgical consent, postoperative 1 week and postoperative 1 month). Surgeons, patients, principal investigator and analysts are blinded to the randomisation assignment.

SETTING

Single, academic, inner city and tertiary care hospital. Data collection began July 16, 2015 and continues to March 2017.

PARTICIPANTS

Patients recruited from nine surgical oncology clinics who are undergoing major cancer surgery.

INTERVENTIONS

In the intervention arm, patients view a patient preparedness video developed through extensive engagement with patients, surgeons and other stakeholders. Patients randomised to the control arm viewed an informational video about the hospital surgical programme.

MAIN OUTCOMES AND MEASURES

Primary Outcome: Patient centredness and ACP of patient-surgeon conversations during the presurgical consent visit as measured through the Roter Interaction Analysis System.

SECONDARY OUTCOMES

patient Hospital Anxiety and Depression Scale score; patient goals of care; patient, companion and surgeon satisfaction; video helpfulness; medical decision maker designation; and the frequency patients watch the video. Intent-to-treat analysis will be used to assess the impact of video assignment on outcomes. Sensitivity analyses will assess whether there are differential effects contingent on patient or surgeon characteristics.

ETHICS AND DISSEMINATION

This study has been approved by the Johns Hopkins School of Medicine institutional review board and is registered on clinicaltrials.gov (NCT02489799, First received: July 1, 2015).

TRIAL REGISTRATION NUMBER

clinicaltrials.gov, NCT02489799.

Transitions from biomedical to recovery-oriented practices in mental health: a scoping review to explore the role of Internet-based interventions

Background

The Internet is transforming mental health care services by increasing access to, and potentially improving the quality of, care. Internet-based interventions in mental health can potentially play a role in transitions from biomedical to recovery-oriented research and practices, but an overview of what this may entail, current work, and issues that need addressing, is lacking. The objective of this study is to describe Internet-based recovery-oriented interventions (referred to as e-recovery) and current research, and to identify gaps and issues relevant to advancing recovery research and practices through opportunities provided by the Internet.

Methods

Five iterative stages of a scoping review framework were followed in searching and analyzing the literature. A recovery framework with four domains and 16 themes was used to deductively code intervention characteristics according to their support for recovery-oriented practices. Only Internet-based interventions used in conjunction with ongoing care were included.

Results

Twenty studies describing six e-recovery interventions were identified and originated in Australia, Finland, the Netherlands, Norway and USA. The domain supporting personal recovery was most clearly reflected in interventions, whereas the last three domains, i.e., promoting citizenship, organizational commitment and working relationship were less evident. Support for the formulation and follow-up of personal goals and preferences, and in accessing peer-support, were the characteristics shared by most interventions. Three of the six studies that employed a comparison group used randomization, and none presented definitive findings. None used recovery-oriented frameworks or specific recovery outcome measures. Four of the interventions were specific to a diagnosis.

Conclusion

Research about how technologies might aid in illuminating and shaping recovery processes is in its formative stages. We recommend that future e-recovery research and innovation attend to four dimensions: evidence-supported interventions, new knowledge about personal recovery, values-based approaches and Internet as a facilitator for organizational transformation. The incremental changes facilitated by e-recovery may help propel a shift in mental health care toward recovery-oriented practices.

A survey of eMedia-delivered interventions for schizophrenia used in randomized controlled trials

BACKGROUND

Randomized trials evaluating electronic Media (eMedia) delivery of interventions are increasingly frequent in mental health. Although a number of reviews have reported efficacy of these interventions, none has reviewed the type of eMedia interventions and quality of their description. We therefore decided to conduct a survey of eMedia-delivered interventions for schizophrenia.

METHODS

We surveyed all relevant trials reliably identified in the Cochrane Schizophrenia Group's comprehensive register of trials by authors working independently. Data were extracted regarding the size of the trial, interventions, outcomes and how well the intervention was described.

RESULTS

eMedia delivery of interventions is increasingly frequent in trials relevant to the care of people with schizophrenia. The trials varied considerably in sample sizes (mean =123, median =87, range =20-507), and interventions were diverse, rarely evaluating the same approaches and were poorly reported. This makes replication impossible. Outcomes in these studies are limited, have not been noted to be chosen by end users and seem unlikely to be easy to apply in routine care. No study reported on potential adverse effects or cost, end users satisfaction or ease of use. None of the papers mentioned the use of CONSORT eHealth guidelines.

CONCLUSION

There is a need to improve reporting and testing of psychosocial interventions delivered by eMedia. New trials should comply with CONSORT eHealth guidance on design, conduct and reporting, and existing CONSORT should be updated regularly, as the field is constantly evolving.

Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits

OBJECTIVE

Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction.

METHODS

327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue.

RESULTS

CAM was discussed in 36 of 327 visits; discussions were brief (

CONCLUSIONS

CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction.

PRACTICE IMPLICATIONS

CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.

Collapse

Key Words

• Clinician satisfaction
• Complimentary and Alternative Medicine (CAM)
• Patient satisfaction
• Patient-physician communication
• Roter Interaction Analysis System (RIAS)

Collapse

MESH Headings

• Adult
• Aged
• Attitude of Health Personnel
• Communication
• Complementary Therapies
• Female
• Health Care Surveys
• Humans
• Male
• Medical Oncology
• Middle Aged
• Neoplasms/therapy
• Office Visits
• Oncologists/psychology
• Patient Satisfaction
• Physician-Patient Relations
• Surveys and Questionnaires
• Tape Recording

Collapse

Grants

• R01 AT006515 NCCIH NIH HHS
• UL1 TR000135 NCATS NIH HHS

Collapse

Affiliation(s) Collapse

Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis

BACKGROUND

In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.

AIMS

To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis.

METHOD

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.

RESULTS

We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09-0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15-18 months (3 RCTs; RR = 0.59, 95% CI 0.35-1.02), with a number needed to treat of approximately 10 (95% CI 5-∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous.

CONCLUSIONS

For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required.

Effectiveness of Social Media Interventions for People With Schizophrenia: A Systematic Review and Meta-Analysis

Background

Recent studies have shown that people with serious mental disorders spend time online for the purposes of disclosure, information gathering, or gaming. However, coherent information on the effects of social media on treatment for people with schizophrenia is still lacking.

Objective

Our aim was to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia.

Methods

A systematic review and meta-analysis were undertaken to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. Ten databases were searched, while search parameters included English-only manuscripts published prior to June 25, 2015. Study appraisals were made independently by 2 reviewers, and qualitative and quantitative syntheses of data were conducted.

Results

Out of 1043 identified records, only two randomized studies of moderate quality (three records, total N=331, duration 12 months) met the inclusion criteria. Participants were people with schizophrenia spectrum or an affective disorder. Social media was used as part of Web-based psychoeducation, or as online peer support (listserv and bulletin board). Outcome measures included perceived stress, social support, and disease-related distress. At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress levels ( P=.04) and showed a trend for a higher perceived level of social support ( P=.06). However, those who reported more positive experiences with the peer support group also reported higher levels of psychological distress ( P=.01).

Conclusions

Despite using comprehensive searches from 10 databases, we found only two studies, whereas numerous reports have been published citing the benefits of social media in mental health. Findings suggest the effects of social media interventions are largely unknown. More research is needed to understand the effects of social media, for users with and without mental illness, in order to determine the impact on mental well-being ofsocial media use as well as its risks.

European Psychiatric Association (EPA) guidance on the quality of eMental health interventions in the treatment of psychotic disorders

The main aim was to develop recommendations on eMental health interventions for the treatment of psychotic disorders. A systematic literature search on eMental health interventions was performed, and 24 articles about interventions in psychotic disorders were retrieved and systematically assessed for their quality. Studies were characterized by a large heterogeneity with regard to study type, sample sizes, interventions and outcome measures. Five graded recommendations were developed dealing with the feasibility of eMental health interventions, beneficial effects of psychoeducation, preliminary results of clinical efficacy, the need of moderation in peer support eMental health groups and the need to develop quality standards.

The impact of watching educational video clips on analogue patients' physiological arousal and information recall

OBJECTIVE

Investigating the influence of watching three educational patient-provider interactions on analogue patients' emotional arousal and information recall.

METHODS

In 75 analogue patients the emotional arousal was measured with physiological responses (electrodermal activity and heart rate) and self-reported arousal.

RESULTS

A moderate increased level of physiological arousal was measured but not too much to inflict emotional distress. Recall of information was within the pursued range.

CONCLUSION

Hence, physiological arousal is not expected to hinder the goals we pursue with our online intervention.

PRACTICE IMPLICATIONS

Still, developers and researchers should remain attentive to the self-reported (conscious) and hidden (subconscious) emotions evoked by the content of educational video clips presented in self-help interventions. A moderate increased level of arousal is preferred to increase the learning capacity. However, too much arousal may decrease the learning capacity and may cause distress, which should obviously be avoided for ethical reasons.

Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions

High quality care in pediatrics involves shared decision making (SDM) between families and providers. The extent to which children with common mental health disorders experience SDM is not well known. The objectives of this study were to examine how parent-reported SDM varies by child health (physical illness, mental health condition, and comorbid mental and physical conditions) and to examine whether medical home care attenuates any differences. We analyzed data on children (2-17 years) collected through the 2009/2010 National Survey of Children with Special Health Care Needs. The sample consisted of parents of children in one of three child health categories: (1) children with a chronic physical illness but no mental health condition; (2) children with a common mental health condition but no chronic physical condition; and (3) children with comorbid mental and chronic physical conditions. The primary dependent variable was parent-report of provider SDM. The primary independent variable was health condition category. Multivariate linear regression analyses were conducted. Multivariate analyses controlling for sociodemographic variables and parent-reported health condition impact indicated lower SDM among children with a common mental health condition-only (B = -0.40; p < 0.01) and children with comorbid conditions (B = -0.67; p < 0.01) compared to children with a physical condition-only. Differences in SDM for children with a common mental health condition-only were no longer significant in the model adjusting for medical home care. However, differences in SDM for children with comorbid conditions persisted after adjusting for medical home care. Increasing medical home care may help mitigate differences in SDM for children with mental health conditions-only. Other interventions may be needed to improve SDM among children with comorbid mental and physical conditions.

Comparison of SGA oral medications and a long-acting injectable SGA: the PROACTIVE study

Until relatively recently, long-acting injectable (LAI) formulations were only available for first-generation antipsychotics and their utilization decreased as use of oral second-generation antipsychotics (SGA) increased. Although registry-based naturalistic studies show LAIs reduce rehospitalization more than oral medications in clinical practice, this is not seen in recent randomized clinical trials. PROACTIVE (Preventing Relapse Oral Antipsychotics Compared to Injectables Evaluating Efficacy) relapse prevention study incorporated efficacy and effectiveness features. At 8 US academic centers, 305 patients with schizophrenia or schizoaffective disorder were randomly assigned to LAI risperidone (LAI-R) or physician's choice oral SGAs. Patients were evaluated during the 30-month study by masked, centralized assessors using 2-way video, and monitored biweekly by on-site clinicians and assessors who knew treatment assignment. Relapse was evaluated by a masked Relapse Monitoring Board. Differences between LAI-R and oral SGA treatment in time to first relapse and hospitalization were not significant. Psychotic symptoms and Brief Psychiatric Rating Scale total score improved more in the LAI-R group. In contrast, the LAI group had higher Scale for Assessment of Negative Symptoms Alogia scale scores. There were no other between-group differences in symptoms or functional improvement. Despite the advantage for psychotic symptoms, LAI-R did not confer an advantage over oral SGAs for relapse or rehospitalization. Biweekly monitoring, not focusing specifically on patients with demonstrated nonadherence to treatment and greater flexibility in changing medication in the oral treatment arm, may contribute to the inability to detect differences between LAI and oral SGA treatment in clinical trials.

Internet communication of outpatients with Asperger's disorder or schizophrenia in Japan

INTRODUCTION

There is insufficient information about the Internet usage of psychiatric patients. The aim of this study is to investigate the usage of Internet communication among subjects with Asperger's disorder (AD) or schizophrenia.

METHODS

A questionnaire survey was carried out in Japan among 29 outpatients with AD, 32 outpatients with schizophrenia, and 97 age-matched normal volunteers. This study limited the participants to young male adults (20- to 39-year-olds) using the Internet.

RESULTS

People with a diagnosis of AD prefer personal computers to mobile phones as their Internet terminal, have an inclination to use anonymous media, and tend to think that they can communicate more correctly through the Internet than face-to-face communication. People with a diagnosis of schizophrenia employ the Internet to a degree almost similar to controls, and tend to rely on unknown persons, but also sometimes feel hurt when communicating on the Internet. Moreover, their sensitivity to the risks of the Internet tends to decrease with the aggravation of their psychotic symptoms.

DISCUSSION

It may be important to pay attention to the excessive use of some limited media by people with a diagnosis of AD. Providing people with a diagnosis of schizophrenia with sufficient information about the risks of the Internet is also important.

Virtual reality for treatment compliance for people with serious mental illness

BACKGROUND

Virtual reality (VR) is computerised real-time technology, which can be used an alternative assessment and treatment tool in the mental health field. Virtual reality may take different forms to simulate real-life activities and support treatment.

OBJECTIVES

To investigate the effects of virtual reality to support treatment compliance in people with serious mental illness.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group Trials Register (most recent, 17th September 2013) and relevant reference lists.

SELECTION CRITERIA

All relevant randomised studies comparing virtual reality with standard care for those with serious mental illnesses. We defined virtual reality as a computerised real-time technology using graphics, sound and other sensory input, which creates the interactive computer-mediated world as a therapeutic tool.

DATA COLLECTION AND ANALYSIS

All review authors independently selected studies and extracted data. For homogeneous dichotomous data the risk difference (RD) and the 95% confidence intervals (CI) were calculated on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed risk of bias and created a 'Summary of findings' table using the GRADE approach.

MAIN RESULTS

We identified three short-term trials (total of 156 participants, duration five to 12 weeks). Outcomes were prone to at least a moderate risk of overestimating positive effects. We found that virtual reality had little effects regarding compliance (3 RCTs, n = 156, RD loss to follow-up 0.02 CI -0.08 to 0.12, low quality evidence), cognitive functioning (1 RCT, n = 27, MD average score on Cognistat 4.67 CI -1.76 to 11.10, low quality evidence), social skills (1 RCT, n = 64, MD average score on social problem solving SPSI-R (Social Problem Solving Inventory - Revised) -2.30 CI -8.13 to 3.53, low quality evidence), or acceptability of intervention (2 RCTs, n = 92, RD 0.05 CI -0.09 to 0.19, low quality evidence). There were no data reported on mental state, insight, behaviour, quality of life, costs, service utilisation, or adverse effects. Satisfaction with treatment - measured using an un-referenced scale - and reported as "interest in training" was better for the virtual reality group (1 RCT, n = 64, MD 6.00 CI 1.39 to 10.61,low quality evidence).

AUTHORS' CONCLUSIONS

There is no clear good quality evidence for or against using virtual reality for treatment compliance among people with serious mental illness. If virtual reality is used, the experimental nature of the intervention should be clearly explained. High-quality studies should be undertaken in this area to explore any effects of this novel intervention and variations of approach.

Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions

BACKGROUND

Internet and mobile-based interventions provide a unique opportunity to deliver cost-effective, accessible, time-unlimited support to people with psychosis. The aims of this study were to systematically compile and analyze the evidence on the acceptability, feasibility, safety and benefits of online and mobile-based interventions for psychosis.

METHODS

Systematic review of peer-reviewed studies examining the usability, acceptability, feasibility, safety or efficacy of user-led, Internet or mobile-based interventions, with at least 80% of participants diagnosed with schizophrenia-spectrum disorders.

RESULTS

Of 38 potentially relevant articles, 12 were eligible for inclusion. Interventions included web-based psycho-education; web-based psycho-education plus moderated forums for patients and supporters; integrated web-based therapy, social networking and peer and expert moderation; web-based CBT; personalized advice based on clinical monitoring; and text messaging interventions. Results showed that 74-86% of patients used the web-based interventions efficiently, 75-92% perceived them as positive and useful, and 70-86% completed or were engaged with the interventions over the follow-up. Preliminary evidence indicated that online and mobile-based interventions show promise in improving positive psychotic symptoms, hospital admissions, socialization, social connectedness, depression and medication adherence.

CONCLUSIONS

Internet and mobile-based interventions for psychosis seem to be acceptable and feasible and have the potential to improve clinical and social outcomes. The heterogeneity, poor quality and early state of current research precludes any definite conclusions. Future research should investigate the efficacy of online and mobile interventions through controlled, well-powered studies, which investigate intervention and patient factors associated with take-up and intervention effects.

The effect of a Web-based education programme (WBEP) on disease severity, quality of life and mothers' self-efficacy in children with atopic dermatitis

AIMS

To develop and evaluate the effects of a web-based education programme in early childhood for children with atopic dermatitis.

BACKGROUND

The prevalence rate of atopic dermatitis is highest in early childhood. A holistic approach is urgently needed for young children with respect to disease severity, quality of life and management, particularly parental knowledge about atopic dermatitis and adherence to treatment.

DESIGN

A quasi-experimental study design was used.

METHODS

A total of 40 mother-child dyads participated in the study from 1 July-30 November 2011 in Korea. All children were under 3 years of age. The programme was based on the Network-Based Instructional System Design model, which consists of five phases: analysis, design, development, implementation and evaluation. The experimental group participated in the programme for 2 weeks. Participants took part in a learning session during the first week and then conducted the practice session at home during the second week. Participant knowledge and compliance were evaluated through online quizzes and self-checklists. Statistical analyses (chi-square test and t-test) were performed using the Statistical Analysis System, Version 9.13.

RESULTS/FINDINGS

There was a significant improvement in disease severity, quality of life and mothers' self-efficacy in the experimental group; thus, the web-based education programme was effective.

CONCLUSION

The web-based education programme as an advanced intervention may be useful in providing basic data for future atopic dermatitis-related studies. Moreover, the programme may serve as a nursing educational intervention tool for clinical nursing practices.

Patients' acceptance towards a web-based personal health record system: an empirical study in Taiwan

The health care sector has become increasingly interested in developing personal health record (PHR) systems as an Internet-based telehealthcare implementation to improve the quality and decrease the cost of care. However, the factors that influence patients' intention to use PHR systems remain unclear. Based on physicians' therapeutic expertise, we implemented a web-based infertile PHR system and proposed an extended Technology Acceptance Model (TAM) that integrates the physician-patient relationship (PPR) construct into TAM's original perceived ease of use (PEOU) and perceived usefulness (PU) constructs to explore which factors will influence the behavioral intentions (BI) of infertile patients to use the PHR. From ninety participants from a medical center, 50 valid responses to a self-rating questionnaire were collected, yielding a response rate of 55.56%. The partial least squares (PLS) technique was used to assess the causal relationships that were hypothesized in the extended model. The results indicate that infertile patients expressed a moderately high intention to use the PHR system. The PPR and PU of patients had significant effects on their BI to use PHR, whereas the PEOU indirectly affected the patients' BI through the PU. This investigation confirms that PPR can have a critical role in shaping patients' perceptions of the use of healthcare information technologies. Hence, we suggest that hospitals should promote the potential usefulness of PHR and improve the quality of the physician-patient relationship to increase patients' intention of using PHR.

A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation

Background

Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes.

Objective

This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders.

Methods

The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation.

Results

In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F_1,68=0.422, P=.52; COMRADE confidence in decision: F_1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams.

Conclusions

The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate.

Trial Registration

Dutch Trial Register (NTR) trial number: 10340; http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=10340 (Archived by WebCite at http://www.webcitation.org/6Jj5umAeS).

[Development and application of a web-based expert system using artificial intelligence for management of mental health by Korean emigrants]

PURPOSE

The purpose of this project was to develop an international web-based expert system using principals of artificial intelligence and user-centered design for management of mental health by Korean emigrants. Using this system, anyone can access the system via computer access to the web.

METHODS

Our design process utilized principles of user-centered design with 4 phases: needs assessment, analysis, design/development/testing, and application release. A survey was done with 3,235 Korean emigrants. Focus group interviews were also conducted. Survey and analysis results guided the design of the web-based expert system.

RESULTS

With this system, anyone can check their mental health status by themselves using a personal computer. The system analyzes facts based on answers to automated questions, and suggests solutions accordingly. A history tracking mechanism enables monitoring and future analysis. In addition, this system will include intervention programs to promote mental health status.

CONCLUSION

This system is interactive and accessible to anyone in the world. It is expected that this management system will contribute to Korean emigrants' mental health promotion and allow researchers and professionals to share information on mental health.