The Effectiveness of a Patient-Centred Assessment with a Solution-Focused Approach (DIALOG+) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care

Abstract

Background: DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focused approach to initiate change. This study tested the effectiveness of DIALOG+ in the community treatment of patients with psychosis. Method: This was a pragmatic, exploratory, parallel-group, cluster-randomised controlled trial. Clinicians within community teams - along with patients with psychosis under their care - were randomised to use DIALOG+ once per month for 6 months or an active control. The primary outcome (subjective quality of life, SQOL) and secondary outcomes were assessed after 3, 6 and 12 months by blinded assessors and analysed using mixed-effect models. Results: A total of 49 clinicians and 179 patients were randomised. Implementation of DIALOG+ was variable, with an average of 1.8 sessions (SD = 1.6) in the first 3 months and 1.1 (SD = 1.2) in the following 3 months. Patients in the DIALOG+ arm had better SQOL at 3, 6 and 12 months (p = 0.035, 0.058 and 0.014, respectively; Cohen's d = 0.29-0.34). They also had significantly fewer unmet needs at 3 and 6 months, fewer general psychopathological symptoms at all time points and better objective social outcomes at 12 months, with no significant differences in other outcomes. Overall care costs were lower in the intervention group. Conclusion: Despite variable implementation, DIALOG+ is a beneficial intervention for community patients with psychosis. As a non-expensive and potentially cost-saving, generic intervention, DIALOG+ may be widely used and may improve the effectiveness of community treatment. Further trials should test DIALOG+ in different patient groups and contexts.

Older Adults' Perspectives on Clinical Research: A Focus Group and Survey Study

“…This movement towards more patient-centered outcomes has seen progress in other areas of mental health and the rest of medicine. For instance, a computer-mediated intervention was developed for patients with psychosis/schizophrenia that makes the assessment of change centered on life domains and issues that patient rate as important to their well-being 37 . Patients randomized to this program report better subjective quality of life and objective social outcomes out to one year compared to those who were randomized to an active control condition.…”

Psychopathological Symptoms and Satisfaction with Mental Health in Patients with Schizophrenia

“…The original 8 studies from which the full sample was drawn consisted of: (1) a Nordic multisite study [7], which investigated predictors of subjective well-being in community patients with schizophrenia in the 5 Nordic countries; (2) an explanatory-model study [8] comparing patients’ explanatory models for schizophrenia across 4 ethnic groups in a London community sample; (3) the DIALOG trial [9], which tested the effectiveness of a structured patient-clinician communication intervention in community samples across 6 European countries; (4) the EDEN trial [10], which compared day hospital versus inpatient treatment in 5 European countries; (5) InvolvE [11], which followed patients who had been involuntarily admitted to 22 UK hospitals; (6) EPOS [12], which tested the advanced DIALOG+ intervention involving a patient-centred solution-focused approach in a London community sample; (7) REFOCUS [13], a 2-site cluster randomised controlled trial testing the effectiveness of a staff-based intervention on recovery for patients with psychosis in England; and (8) NESS [14], which was a randomized controlled trial to examine the effectiveness of body psychotherapy for schizophrenia in several UK sites.…”

Beyond Assessment of Quality of Life in Schizophrenia

“…The effectiveness and cost-effectiveness of DIALOG+ were compared to standard care in a randomized controlled trial conducted in the United Kingdom including patients with psychotic disorders (Priebe et al 2015 ). DIALOG+ improved QoL independently from symptoms, similarly to DIALOG.…”

“…This can favor a shared understanding of problems and increase collaborative care planning (Slade 2002b ;Priebe et al 2015 ). The assessment is more likely to infl uence clinician and patient behaviors if conducted collaboratively during the clinical meetings (as opposed to separately outside of the clinical meeting).…”

“…Hence, routine QoL assessment can be a starting point for brief psychological interventions within the routine clinical meetings, which may increase the therapeutic value of such meetings (Priebe et al 2015 ). In particular, it has been suggested that having a psychological model of reference improves the communication between patients and clinicians (Priebe et al 2011b ).…”