Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making

A cluster randomised controlled trial in a specialist mental health outpatient setting

M. Metz, l. Elfeddali, M. Verbeek, E. de Beurs, A. Beekman, C.M. van der Feltz-Cornelis

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Abstract

Objective

To investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process.

Methods

The study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored.

Results

At T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (beta 7.553, p = 0.038, 95% CI: 0.403-14.703, d = 0.32) and reduction of symptoms (beta - 7.276, p = 0.0497, 95% CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (beta = -0.457, p = 0.000, 95% CI:-0.518-0.396, d = -1.31), which was associated with better treatment outcomes.

Conclusion 

Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.

Original languageEnglish
Article number0199795
Number of pages18
JournalPLoS ONE
Volume13
Issue number6
DOIs
Publication statusPublished - 2018

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Mental Health
Outpatients
Decision making
Health
Patient Participation
Intention to Treat Analysis
Conflict (Psychology)

Keywords

  • Adult
  • Ambulatory Care/methods
  • Decision Making
  • Female
  • Humans
  • Male
  • Mental Disorders/psychology
  • Mental Health
  • Middle Aged
  • Patient Compliance
  • Surveys and Questionnaires
  • Telemedicine

Cite this

@article{f38e687aac854763acec4777a6f49da7,
title = "Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making: A cluster randomised controlled trial in a specialist mental health outpatient setting",
abstract = "ObjectiveTo investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process.MethodsThe study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored.ResultsAt T1, 200 patients participated (47{\%} intervention, 53{\%} control), and at T2 175 patients (47{\%} intervention, 53{\%} control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (beta 7.553, p = 0.038, 95{\%} CI: 0.403-14.703, d = 0.32) and reduction of symptoms (beta - 7.276, p = 0.0497, 95{\%} CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (beta = -0.457, p = 0.000, 95{\%} CI:-0.518-0.396, d = -1.31), which was associated with better treatment outcomes.Conclusion Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.",
keywords = "Adult, Ambulatory Care/methods, Decision Making, Female, Humans, Male, Mental Disorders/psychology, Mental Health, Middle Aged, Patient Compliance, Surveys and Questionnaires, Telemedicine",
author = "M. Metz and l. Elfeddali and M. Verbeek and {de Beurs}, E. and A. Beekman and {van der Feltz-Cornelis}, C.M.",
year = "2018",
doi = "10.1371/journal.pone.0199795",
language = "English",
volume = "13",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "PUBLIC LIBRARY SCIENCE",
number = "6",

}

TY - JOUR

T1 - Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making

T2 - A cluster randomised controlled trial in a specialist mental health outpatient setting

AU - Metz, M.

AU - Elfeddali, l.

AU - Verbeek, M.

AU - de Beurs, E.

AU - Beekman, A.

AU - van der Feltz-Cornelis, C.M.

PY - 2018

Y1 - 2018

N2 - ObjectiveTo investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process.MethodsThe study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored.ResultsAt T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (beta 7.553, p = 0.038, 95% CI: 0.403-14.703, d = 0.32) and reduction of symptoms (beta - 7.276, p = 0.0497, 95% CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (beta = -0.457, p = 0.000, 95% CI:-0.518-0.396, d = -1.31), which was associated with better treatment outcomes.Conclusion Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.

AB - ObjectiveTo investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process.MethodsThe study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored.ResultsAt T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (beta 7.553, p = 0.038, 95% CI: 0.403-14.703, d = 0.32) and reduction of symptoms (beta - 7.276, p = 0.0497, 95% CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (beta = -0.457, p = 0.000, 95% CI:-0.518-0.396, d = -1.31), which was associated with better treatment outcomes.Conclusion Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.

KW - Adult

KW - Ambulatory Care/methods

KW - Decision Making

KW - Female

KW - Humans

KW - Male

KW - Mental Disorders/psychology

KW - Mental Health

KW - Middle Aged

KW - Patient Compliance

KW - Surveys and Questionnaires

KW - Telemedicine

U2 - 10.1371/journal.pone.0199795

DO - 10.1371/journal.pone.0199795

M3 - Article

VL - 13

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 6

M1 - 0199795

ER -