Provider Perspectives on Implementing Shared Decision Making for PTSD Treatment in VA Primary Care

Chen, Jessica; Matson, Theresa E.; Lehavot, Keren; Raue, Patrick J.; Young, J. P.; Silvestrini, Molly; Fortney, John C.; Williams, Emily C.

doi:10.1007/s10488-021-01119-5

Cited by 3 publications

(4 citation statements)

References 38 publications

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“…Our results also suggest that participating in an individual session may lead to decreases in the percentage of veterans that do not respond to EBP treatment outreach or decline to engage in at least one EBP session as compared to other models. These data, collected over the course of program transition from group format (Model 1) to a hybrid model (Model 2) and finally to a fully individual model (Model 3), support research highlighting the benefits of incorporating SDM and patient-centered care into PTSD treatment (Chen et al, 2021;Etingen et al, 2022;Trusty et al, 2019). Beyond treatment planning models, several other clinic and demographic changes may have influenced our findings.…”

Section: Discussionsupporting

confidence: 65%

“…This highly individualized approach to health care has been used in the context of care for a range of medical and mental health conditions or concerns including specialty areas of medicine (e.g., Beaver et al, 2005; Cheng et al, 2020), depression (Raue et al, 2010), and serious mental illness (Mahone, 2008; Zisman-Ilani et al, 2021). Research on SDM indicates that it is a model that may enhance engagement with treatment across a number of conditions, providing benefit to both patients and providers (Chen et al, 2021; Etingen et al, 2022; Trusty et al, 2019). Use of SDM has shown specific benefit in the outpatient treatment of PTSD, where research indicates that early collaboration with patients in treatment choice may increase selection and reception of EBPs (Mott et al, 2014; Watts et al, 2015).…”

Section: Objectivementioning

confidence: 99%

See 1 more Smart Citation

Improving engagement and retention to treatment within VHA PTSD specialty care: Evolution of an outpatient program design.

Hessinger¹,

Etingen²,

Larsen³

et al. 2023

Psychological Services

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The Veteran's Health Administration (VA) and Department of Defense (DoD) posttraumatic stress disorder (PTSD) clinical practice guidelines (2017) recommend individual, trauma-focused therapy as the gold standard of treatment for PTSD (i.e., evidence-based practices [EBP]). Moreover, these guidelines encourage the use of individual shared decision-making (SDM) to increase engagement and completion of EBPs for PTSD in line with current literature. This study retrospectively evaluated three models of program design of a VA PTSD specialty clinic over the past 8 years. In line with previous literature, the study hypothesized that leveraging individualized SDM in the clinic design would lead to increased completion of EBPs for PTSD. Analyses indicated an impact as the models shifted from a group-based model to an individualized model. Specifically, as compared to veterans who completed a group-based design, a greater proportion of those enrolled in the clinic were more likely to complete an EBP. These results may suggest that individualized, patient-centered treatment planning may be related to patient engagement in EBPs for PTSD in contrast with group-based models. Other programmatic changes, such as changes in treatment options presented to patients, a movement to focus on EBPs for PTSD, and expanded clinic hours and telehealth options, possibly impacted veteran engagement and completion in EBPs. The study highlights the potential impacts of a changing patient population within the clinic over a relatively short period. The observations are discussed, and limitations are highlighted. The study shares the hope for additional randomized prospective studies of program designs. Impact StatementThis study examines the evolution of an outpatient VA PTSD clinical team as practices moved from group-based model to a more individualized, veteran-centric model. This study underscores the positive impact of a programmatic shift toward individualized care that occurred in concurrence with additional demographic shifts in the veteran clinical population, and availability of remote care options delivered via telehealth. Further clinical research is needed.

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Section: Discussionsupporting

confidence: 65%

Section: Objectivementioning

confidence: 99%

Improving engagement and retention to treatment within VHA PTSD specialty care: Evolution of an outpatient program design.

Hessinger¹,

Etingen²,

Larsen³

et al. 2023

Psychological Services

View full text Add to dashboard Cite

show abstract

“…Future interventions may consider targeting how TFPs are introduced to patients. For example, shared decision-making tools may be a promising approach for future implementation efforts designed to engage patients and providers in discussions about TFP (Chen et al, 2021;Mott et al, 2014;Watts et al, 2015). Shared decision-making helps patients make informed choices about treatment after a supportive discussion with their provider to clarify treatment goals, explain the clinical effectiveness and burdens of available treatment options, and assist in the choice of treatment that best matches the patient's preferences and values (Elwyn et al, 2012(Elwyn et al, , 2017.…”

Section: Discussionmentioning

confidence: 99%

A mixed‐methods evaluation of why an implementation trial failed to engage veterans with posttraumatic stress disorder in trauma‐focused psychotherapy

Fortney

Rajan

Chen

et al. 2023

Journal of Traumatic Stress

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An effectiveness trial found that telemedicine collaborative care for posttraumatic stress disorder (PTSD) significantly increased engagement in trauma‐focused psychotherapy (TFP) and improved PTSD symptoms. However, in a subsequent implementation trial, very few veterans enrolled in collaborative care initiated TFP. We conducted a mixed‐methods evaluation to determine why veterans did not initiate TFP in the implementation trial. After conducting chart reviews of 1,071 veterans with PTSD enrolled in collaborative care, patients were categorized into four mutually exclusive TFP groups: TFP not discussed; TFP discussed, declined; TFP discussed, did not decline; and TFP initiated. We conducted semistructured interviews with 43 unique patients and 58 unique providers (i.e., care managers and mental health specialists). Almost half (48.6%) of the veterans had no documentation of discussing TFP with their care manager; another 28.9% discussed it but declined. Most veterans (77.1%) had an encounter with a mental health specialist, 36.8% of whom never discussed TFP, and 35.7% of whom discussed it but declined. Providers reported that many veterans were not able, willing, or ready to engage in TFP and that non–trauma‐focused therapies were better aligned with their treatment goals. Veterans gave numerous reasons for not initiating TFP, including having bad prior experiences with TFP and wanting to avoid thinking about past traumatic experiences.Commonly cited reasons for noninitiation were providers never discussing TFP with veterans and veterans declining TFP after discussing it with their provider. Interventions, such as shared decision‐making tools, may be needed to engage providers and patients in informed discussions about TFP.

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“…Although there is an increased appreciation of CDM and person-centred mental healthcare by military bodies, it has been mostly related to PTSD, most of the work was conducted within the USA and implementation remains challenging. [15][16][17][18][19] Facing the growing need to improve veterans' mental healthcare, this commentary illuminates clinical challenges for implementing CDM in military settings, focusing on veterans in the USA with mental illness.…”

mentioning

confidence: 99%

Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations

et al. 2023

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Provider Perspectives on Implementing Shared Decision Making for PTSD Treatment in VA Primary Care

Cited by 3 publications

References 38 publications

Improving engagement and retention to treatment within VHA PTSD specialty care: Evolution of an outpatient program design.

Improving engagement and retention to treatment within VHA PTSD specialty care: Evolution of an outpatient program design.

A mixed‐methods evaluation of why an implementation trial failed to engage veterans with posttraumatic stress disorder in trauma‐focused psychotherapy

Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations

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