Shared decision-making in mental health care using routine outcome monitoring: Results of a cluster randomised-controlled trial

M.J. Metz, M.A. Verbeek, J.W.R. Twisk, C.M. van der Feltz-Cornelis, E. de Beurs, A.T.F. Beekman

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Purpose:
To investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients' perception of Decisional Conflict (DC), which measures patients' engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes.

Method:
Multi-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC.

Results:
Seven teams were randomised to each arm. T0 was completed by 186 patients (51% intervention; 49% control) and T1 by 158 patients (51% intervention, 49% control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =- 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = - 0.45; ROM: p = 0.021, d = - 0.32), which was associated with better treatment outcomes.

Conclusion:
Except for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR.
Original languageEnglish
Pages (from-to)209–219
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume54
Issue number2
DOIs
Publication statusPublished - 2019

Fingerprint

Mental Health
mental health
health care
monitoring
Delivery of Health Care
decision making
mood
Patient Participation
Intention to Treat Analysis
Conflict (Psychology)
regression
SDM

Keywords

  • CONFLICT
  • Cluster randomised-controlled trial
  • Decisional conflict
  • FEEDBACK
  • IMPROVEMENT
  • INVOLVEMENT
  • Outcome measurements
  • Routine outcome monitoring
  • SCALE
  • Shared decision-making

Cite this

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title = "Shared decision-making in mental health care using routine outcome monitoring: Results of a cluster randomised-controlled trial",
abstract = "Purpose: To investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients' perception of Decisional Conflict (DC), which measures patients' engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes.Method: Multi-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC.Results: Seven teams were randomised to each arm. T0 was completed by 186 patients (51{\%} intervention; 49{\%} control) and T1 by 158 patients (51{\%} intervention, 49{\%} control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =- 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = - 0.45; ROM: p = 0.021, d = - 0.32), which was associated with better treatment outcomes.Conclusion: Except for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR.",
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author = "M.J. Metz and M.A. Verbeek and J.W.R. Twisk and {van der Feltz-Cornelis}, C.M. and {de Beurs}, E. and A.T.F. Beekman",
year = "2019",
doi = "10.1007/s00127-018-1589-8",
language = "English",
volume = "54",
pages = "209–219",
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issn = "0933-7954",
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Shared decision-making in mental health care using routine outcome monitoring : Results of a cluster randomised-controlled trial. / Metz, M.J.; Verbeek, M.A.; Twisk, J.W.R.; van der Feltz-Cornelis, C.M.; de Beurs, E.; Beekman, A.T.F.

In: Social Psychiatry and Psychiatric Epidemiology, Vol. 54, No. 2, 2019, p. 209–219.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Shared decision-making in mental health care using routine outcome monitoring

T2 - Results of a cluster randomised-controlled trial

AU - Metz, M.J.

AU - Verbeek, M.A.

AU - Twisk, J.W.R.

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

AU - de Beurs, E.

AU - Beekman, A.T.F.

PY - 2019

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N2 - Purpose: To investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients' perception of Decisional Conflict (DC), which measures patients' engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes.Method: Multi-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC.Results: Seven teams were randomised to each arm. T0 was completed by 186 patients (51% intervention; 49% control) and T1 by 158 patients (51% intervention, 49% control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =- 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = - 0.45; ROM: p = 0.021, d = - 0.32), which was associated with better treatment outcomes.Conclusion: Except for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR.

AB - Purpose: To investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients' perception of Decisional Conflict (DC), which measures patients' engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes.Method: Multi-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC.Results: Seven teams were randomised to each arm. T0 was completed by 186 patients (51% intervention; 49% control) and T1 by 158 patients (51% intervention, 49% control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =- 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = - 0.45; ROM: p = 0.021, d = - 0.32), which was associated with better treatment outcomes.Conclusion: Except for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR.

KW - CONFLICT

KW - Cluster randomised-controlled trial

KW - Decisional conflict

KW - FEEDBACK

KW - IMPROVEMENT

KW - INVOLVEMENT

KW - Outcome measurements

KW - Routine outcome monitoring

KW - SCALE

KW - Shared decision-making

U2 - 10.1007/s00127-018-1589-8

DO - 10.1007/s00127-018-1589-8

M3 - Article

VL - 54

SP - 209

EP - 219

JO - Social Psychiatry and Psychiatric Epidemiology

JF - Social Psychiatry and Psychiatric Epidemiology

SN - 0933-7954

IS - 2

ER -