A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation

Abstract

BackgroundMental 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.ObjectiveThis 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.MethodsThe 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.ResultsIn 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: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=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.ConclusionsThe 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 RegistrationDutch 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).

Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up

“…A survey conducted in 2011 of people with mental illness (the majority of whom experienced psychosis) demonstrated that people who had been unwell for longer were at risk of digital exclusion, and that service users from black and minority ethnic (BME) groups were more likely to access public Internet facilities rather than personal devices [6], which may affect the privacy of their health data. Other studies indicate that people with longer-term psychotic illnesses have showed higher rates of independent use of digital tools than people using early intervention services [7]…”

Trends and perspectives of shared decision-making in schizophrenia and related disorders

“…The controlled trial with forensic patients[22 ] showed a nonsignificant reduction of violent and criminal behavior when the patients' caregivers participated in a training addressing risk assessment and shared care planning.Regarding decision support systems, Stein et al[21 && ] found no significant results on adherence rates, but did not report on other outcomes. Another online tool (Van der Krieke et al[23 …”

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

“…Service users considered most of the automatically generated advice relevant. The tool is deemed feasible.Wegweis [56]To investigate the intervention in naturalistic settingAn open-label, 2-group, parallel RCT with patients with psychosis ( N  = 250) recruited from two outpatient teams, and process evaluation with open interviews with patients ( n  = 15), observation of discussions, and a questionnaire among clinicians.Primary outcome: Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Secondary outcome: Client Satisfaction Questionnaire (CSQ).Inconclusive results on service users’ satisfaction and involvement in decision-making.…”

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