Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice

Abstract

Numerous trials demonstrate that monitoring client progress and using feedback for clinical decision-making enhances treatment outcomes, but available data suggest these practices are rare in clinical settings and no psychometrically validated measures exist for assessing attitudinal barriers to these practices. This national survey of 504 clinicians collected data on attitudes toward and use of monitoring and feedback. Two new measures were developed and subjected to factor analysis: The monitoring and feedback attitudes scale (MFA), measuring general attitudes toward monitoring and feedback, and the attitudes toward standardized assessment scales-monitoring and feedback (ASA-MF), measuring attitudes toward standardized progress tools. Both measures showed good fit to their final factor solutions, with excellent internal consistency for all subscales. Scores on the MFA subscales (Benefit, Harm) indicated that clinicians hold generally positive attitudes toward monitoring and feedback, but scores on the ASA-MF subscales (Clinical Utility, Treatment Planning, Practicality) were relatively neutral. Providers with cognitive-behavioral theoretical orientations held more positive attitudes. Only 13.9 % of clinicians reported using standardized progress measures at least monthly and 61.5 % never used them. Providers with more positive attitudes reported higher use, providing initial support for the predictive validity of the ASA-MF and MFA. Thus, while clinicians report generally positive attitudes toward monitoring and feedback, routine collection of standardized progress measures remains uncommon. Implications for the dissemination and implementation of monitoring and feedback systems are discussed.

Shared decision‐making in mental and behavioural health interventions

“…In spite of commonly‐held beliefs in the validity of clinicians' judgement and decision‐making, research indicates that clinical judgement is often flawed and improves only marginally with training and experience . The consequences of overconfidence in one's judgment may be compounded by the lack of feedback many clinicians receive regarding the success of the interventions they choose . Because many clinicians do not regularly monitor outcomes, they may believe that their patients are progressing satisfactorily with a paternalistic approach, even if that is not the case .…”

“…51 The consequences of overconfidence in one's judgment may be compounded by the lack of feedback many clinicians receive regarding the success of the interventions they choose. 52 Because many clinicians do not regularly monitor outcomes, they may believe that their patients are progressing satisfactorily with a paternalistic approach, even if that is not the case. 53 Additionally, clinicians may perceive cases with negative treatment outcomes as within the scope of normal practice given the long-standing "rule of thirds," in which one third of patients recover, one third partially recover, and one third do not recover.…”

Implementing measurement based care in community mental health: a description of tailored and standardized methods

“…Social network analysis was used to identify two opinion leaders from each clinic’s baseline advice networks; specifically, opinion leaders who had the highest in-degree centrality (a measure of influence; [ 21 ]) and spanned the network. Two attitudinal measures [ 5 ] were used to identify two clinicians who strongly endorsed positive attitudes toward MBC to serve as champions on the team. Teams were charged with advancing MBC through the phases of implementation, communicating with other stakeholders, engaging in data-based decision making, increasing buy-in, problem-solving, and identifying barriers and finding solutions, for instance [ 22 ].…”

“…Measurement based care is an evidence-based practice (EBP) that involves the routine use of standardized assessment results (i.e., Patient Health Questionnaire, PHQ-9 for depression severity [ 1 ]) to guide psychotherapy practice [ 2 ], but this practice is used by fewer than 20% of behavioral health clinicians in the United States [ 3 – 5 ]. Implementation science has emerged to address this research-to-practice gap.…”

Behavioral Economics Interventions in Clinical Decision Support Systems

“…The 12 selected articles reported on 10 distinct studies. Among these studies, three addressed monitoring and individual feedback [32][33][34], two compared framed presentations [35,36], two addressed heuristics [37,38] and [39], one was about social norms [40], one addressed the ordering effect [41], and one used a combination of overconfidence, risk aversion, and herding [42,43]. Figure 1 presents the flowchart of this systematic review.…”