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

Abstract

ObjectiveTo 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.MethodsThe 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.ResultsAt 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.ConclusionAlthough, 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.

Patients' and clinicians' perspectives on shared decision‐making regarding treatment decisions for depression, anxiety disorders, and obsessive‐compulsive disorder in specialized psychiatric care

“…Although this could have influenced our results, research shows that to this date, SDM is still not widely implemented in mental health care . Furthermore, recent literature shows that the difficulties we identified regarding the implementation of SDM in clinical practice seem similar across different patient groups and health care settings . This suggests that despite SDM developments in recent years, our findings are still relevant, and our conclusions may be applicable in a wider range of health care area's in the Netherlands and internationally.…”

“…Yet effects on SDM and health service outcomes remain inconclusive, and SDM is not yet widely implemented across mental health care settings . Some authors suggested that the effects of decision aids are weak, because of a less than optimal uptake of interventions/tools in current clinical practice, and that incentives might be needed to stimulate SDM and the use of DAs and other SDM interventions . In addition, Metz et al found an effect only for mood disorders and not for other diagnoses, suggesting that their SDM intervention might have been too generic.…”

“…18 Some authors suggested that the effects of decision aids are weak, because of a less than optimal uptake of interventions/tools in current clinical practice, and that incentives might be needed to stimulate SDM and the use of DAs and other SDM interventions. 36,42,43 In addition, Metz et al 35 found an effect only for mood disorders and not for other diagnoses, suggesting that their SDM intervention might have been too generic. Tailoring interventions to patient groups and decision topics may be necessary to improve results.…”

“…[34][35][36][37][38][39][40] These interventions/tools are mostly based on the theoretical SDM construct and related steps as described above or inspired by existing initiatives in other clinical fields. Interventions include traditional decision aids (DAs) for use before the consultation that contain information about treatment options and ask patients about experiences and preferences (and can also be taken to the consultation) 37 ; shorter versions for use by patients and clinicians together (eg, Option Grids 34 ); web-based decision support systems (eg, Common Ground web application, 38 computerized clinical decision support tool [CDST], 39 and e-health programs using routine outcome monitoring [SDM-DI] 35,36,41 ). Most SDM interventions resulted in better informed patients, showed an increase of consumer involvement facilitated by the clinician, an increase of consumer satisfaction and treatment adherence, and often resulted in less decisional conflict (DC).…”

“…Most SDM interventions resulted in better informed patients, showed an increase of consumer involvement facilitated by the clinician, an increase of consumer satisfaction and treatment adherence, and often resulted in less decisional conflict (DC). 18,[35][36][37]41,42 Yet effects on SDM and health service outcomes remain inconclusive, and SDM is not yet widely implemented across mental health care settings. 18 Some authors suggested that the effects of decision aids are weak, because of a less than optimal uptake of interventions/tools in current clinical practice, and that incentives might be needed to stimulate SDM and the use of DAs and other SDM interventions.…”