Health Service and Population Research Department P029, David Goldberg Centre, King's College London Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
BMC Psychiatry. 2012 Aug 31;12:133. doi: 10.1186/1471-244X-12-133.
The UK Equality Act 2010 makes it unlawful for employers to ask health questions before making an offer of employment except in certain circumstances. While the majority of employers would prefer applicants to disclose a mental illness at the application stage, many people either wait until they have accepted the job and then disclose to an occupational health professional, or do not do so at all due to the anticipation of discrimination or a wish for privacy. However, non disclosure precludes the ability to request reasonable adjustments in the workplace or to make a claim of direct discrimination. Disclosure to employers is therefore a difficult decision. A recent pilot study by our group of the CORAL decision aid showed that it helped mental health service users clarify their needs and values regarding disclosure and led to reduction in decisional conflict. The present proof of concept trial aims to determine whether a full scale randomised controlled trial (RCT) is justifiable and feasible, and to optimise its design.
In this single blind exploratory RCT in London, a total of 80 participants (inclusion criteria: age ≥ 18 years, on the caseload of a specialist employment adviser working with people with mental illness; referred to the adviser either from primary care via Improving Access to Psychological Therapies or secondary mental health service; currently seeking or interested in either paid or voluntary employment, and a Decisional Conflict Scale score of 37.5 or greater and stage of decision score 1-5) will be recruited from vocational advice services. After completing a baseline assessment, participants will be randomly assigned to one of two conditions (1) Use of the CORAL Decision Aid (DA) in addition to treatment as usual or (2) Treatment as usual. Those allocated to the DA condition will be given it to read and complete, and the researcher will be present to record the time taken and any content that causes confusion. Intervention participants may keep the decision aid but are discouraged from showing it to other service users to avoid contamination. Follow up interviews will be conducted at 3 months. Primary outcomes are: (i) stage of decision making score; (ii) decisional conflict scores and (iii) employment related outcomes. Secondary analyses will identify predictors of disclosure and qualitative analysis will explore the impact of the intervention.
A reduction in decisional conflict regarding disclosure leading to more effective job seeking activity could have significant economic consequences for people with mental illness in terms of employment rates and productivity.
NCT01379014 (ClinicalTrials.gov Identifier).
2010 年英国平等法案规定，雇主除某些情况下外，不得在提供工作机会前询问健康问题。虽然大多数雇主更希望申请人在申请阶段披露精神疾病，但许多人要么等到接受工作后再向职业健康专业人员披露，要么由于担心歧视或希望保护隐私而根本不披露。然而，不披露会妨碍在工作场所提出合理调整或提出直接歧视的主张。因此，向雇主披露是一个艰难的决定。我们小组最近对 CORAL 决策辅助工具进行的试点研究表明，它有助于精神卫生服务使用者澄清他们在披露方面的需求和价值观，并减少决策冲突。本概念验证试验旨在确定是否有理由进行全面的随机对照试验（RCT），以及是否可行，并优化其设计。
在伦敦进行的这项单盲探索性 RCT 中，共有 80 名参与者（纳入标准：年龄≥18 岁，在为精神疾病患者提供服务的专家就业顾问的病例中；通过改善获得心理治疗的机会或二级精神卫生服务转介给顾问；目前正在寻找或有兴趣从事有偿或志愿工作，且决策冲突量表得分为 37.5 或更高，决策阶段得分为 1-5）将从职业咨询服务中招募。完成基线评估后，参与者将被随机分配到以下两种条件之一：（1）在常规治疗的基础上使用 CORAL 决策辅助工具（DA），或（2）仅接受常规治疗。分配到 DA 条件的参与者将阅读并完成该决策辅助工具，研究人员将在场记录所用时间和任何引起混淆的内容。干预参与者可以保留决策辅助工具，但不鼓励他们向其他服务用户展示，以避免受到影响。将在 3 个月时进行随访访谈。主要结果是：（i）决策阶段得分；（ii）决策冲突得分和（iii）与就业相关的结果。次要分析将确定披露的预测因素，定性分析将探讨干预的影响。
在披露方面减少决策冲突，从而使求职活动更有效，这可能会对精神疾病患者的就业率和生产力产生重大的经济效益。
NCT01379014（ClinicalTrials.gov 标识符）。
