Quantifying the treatment goals of people recently diagnosed with schizophrenia using best–worst scaling

Abstract

ObjectiveThis study seeks to quantify the treatment goals of people recently diagnosed with schizophrenia and explore their impact on treatment plan.MethodsPeople aged 18–35 years with a confirmed diagnosis of schizophrenia within the past 5 years were surveyed in the UK, Germany, and Italy. Treatment goals were assessed via a validated best–worst scaling instrument, where participants evaluated subsets of 13 possible treatment goals identified using a balanced incomplete block design. Participants identified the most and least important goals within each task. Data were also collected on current treatment and preference for daily oral versus long-acting injectable (LAI) treatment. Hierarchical Bayes was used to identify preference weights for the goals, and latent class analysis was used to identify segments of people with similar goals. The segments were compared with the current treatment and preference for oral versus LAI treatment.ResultsAcross 100 participants, the average age was 26 years, 75% were male and 50% were diagnosed within 2 years ago. Overall, preferences were most favorable for reduced disease symptoms, think clearly, reduced hospitalizations, reduced anxiety, and take care of self. A total of 61% preferred oral medication and 39% LAI. Two groups were identified with different treatment goals; 50% of participants emphasized clinical goals, including reduced disease symptoms (preference weight =19.7%), reduced hospitalizations (15.5%), and reduced anxiety (10.5%). The other 50% emphasized functional goals, including improved relationships with family/friends (11.4%), increased interest in work (10.6%), experiencing a fuller range of emotions (8.4%), and ability to socialize (7.5%). Those emphasizing functional goals were more likely to be on LAI (44% versus 26%; p=0.059) and preferred LAI (46% versus 32%; p=0.151).ConclusionsPeople with recent-onset schizophrenia may focus more on clinical goals or functional goals, a discussion of which may help facilitate patient engagement.

Hospitalization Rates and Therapy Costs of German Schizophrenia Patients Who are Initiated on Long-Acting Injectable Medication: A Mirror-Image Study

“…While some patients prefer LAIs over OAPs due to increased relapse prevention [48] as well as better quality of life [49], others report being coerced into undergoing treatment with LAIs [50]; with pain at the injection site, misconceptions regarding LAIs, and lack of awareness also being reported as reasons for low LAI uptake [51,52]. Bridges et al [53] recently quantified the effect of schizophrenia treatment goals on a patient's treatment plan. In this study, patients who had functional goals such as improving social relationships, increasing interest in work, and experiencing full range of emotions were more likely to prefer LAIs over OAPs.…”

Short-acting antipsychotics or long-acting injectables? A treatment comparison in patients with schizophrenia

“…On the other hand, patients often feel insufficiently informed about the potential advantages of LAIs [45], such as reduction of relapses and hospitalizations, the steady levels and constant effects of the active substance, and avoidance of being constantly reminded of the disease by daily medication intake. It is striking that patients who have experience with LAIs tend to prefer this mode of treatment [3]. In this context, de Berardis compares the advantages and disadvantages of the usage of second-generation LAIs as a first-line treatment for schizophrenia and points out that LAIs can have a positive impact on treatment outcomes, especially in terms of adherence and relapse prevention [47].…”

“…Our findings presented here further indicate that LAIs should be offered to patients much more consistently than it is currently done, possibly even repeatedly. It is particularly important for the patient to avoid hospitalization [3] and this could be a good argument when discussing possible treatment strategies with the patient. Important points to consider in such discussions have recently been collected and reviewed by an expert panel [28].…”

“…The health, social, and economic burdens related to schizophrenia are tremendous, not only for patients but also for families, other caregivers, and the broader society. The World Health Organization estimates that direct costs of schizophrenia range from 1.6 % to 2.6 % of total health care expenditures in western countries [2,3]. The number of lost working days and early retirements due to mental disorders has steadily increased in recent years and is a heavy burden for society and pension insurance institutions.…”

The Patient, Investigator, Nurse, Carer Questionnaire (PINC-Q): A Cross-Sectional, Retrospective, Non-Interventional Study Exploring the Impact of Less Frequent Medication Administration with Paliperidone Palmitate 3-Monthly as Maintenance Treatment for Schizophrenia

“…In a recent Scandinavian study, patients treated with PP3M who were interviewed about several aspects of their treatment, highlighted the importance of their relationship with their healthcare teams in the success of their schizophrenia treatment [25]. Theoretically, switching to less frequent antipsychotic administration should also allow more time to discuss other important topics with the patient, including functional goals that are important to a patient's recovery, such as improving relationships with friends and family, gaining employment and increasing social activities [17,26,27]. In the current study, switching to PP3M resulted in increased time spent discussing non-medication topics for some; however, it was most frequently reported that there was 'no change'.…”