McLean Hospital, Proctor House 3 MS 222, 115 Mill St, Belmont, MA 02478, USA.
J Clin Psychiatry. 2013 Jun;74(6):595-602. doi: 10.4088/JCP.12r07757.
Evidence-based practice involves the consideration of efficacy and effectiveness, clinical expertise, and patient preference in treatment selection. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders.
A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration library through August 2011 for studies written in English that assessed adult patient preferences for the treatment of psychiatric disorders. The following search terms and subject headings were used in combination: patient preference, consumer preference, therapeutics, psychotherapy, drug therapy, mental disorders, depression, anxiety, insomnia, bipolar disorder, schizophrenia, substance-related disorder, eating disorder, and personality disorder. In addition, the reference sections of identified articles were examined to locate any additional articles not captured by this search.
Studies that assessed preferred type of treatment and included at least 1 psychological treatment and 1 pharmacologic treatment were included. Of the 644 articles identified, 34 met criteria for inclusion.
Authors extracted relevant data including the proportion of participants reporting preference for psychological or pharmacologic treatment.
The proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69-0.80), which was significantly higher than equivalent preference (ie, higher than 0.50; P < .001). Sensitivity analyses suggested that younger patients (P = .05) and women (P < .01) were significantly more likely to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected (ie, non-treatment-seeking) samples (P < .001 for both) but was somewhat stronger for unselected samples.
Aggregation of patient preferences across diverse settings yielded a significant 3-fold preference for psychological treatment. Given evidence for enhanced outcomes among those receiving their preferred psychiatric treatment and the trends for decreasing utilization of psychotherapy, strategies to maximize the linkage of patients to preferred care are needed.
循证实践涉及在治疗选择中考虑疗效和有效性、临床专业知识以及患者的偏好。然而，对精神科治疗的患者偏好研究较少。本荟萃分析的目的是提供一个估计，即相对于精神障碍的药物治疗，有多少患者更倾向于心理治疗。
通过在 2011 年 8 月之前使用 PubMed、PsycINFO 和 Cochrane 合作图书馆的文献检索，评估了评估成年患者对精神障碍治疗的偏好的英文研究。使用了以下搜索词和主题词的组合：患者偏好、消费者偏好、治疗、心理疗法、药物治疗、精神障碍、抑郁、焦虑、失眠、双相情感障碍、精神分裂症、物质相关障碍、饮食障碍和人格障碍。此外，还检查了已确定文章的参考文献部分，以找到未通过此搜索捕获的任何其他文章。
评估首选治疗类型并包括至少 1 种心理治疗和 1 种药物治疗的研究包括在内。在确定的 644 篇文章中，有 34 篇符合纳入标准。
作者提取了相关数据，包括报告偏好心理或药物治疗的参与者的比例。
选择心理治疗的成年患者比例为 0.75（95%置信区间，0.69-0.80），显著高于等效偏好（即高于 0.50；P<.001）。敏感性分析表明，年轻患者（P=.05）和女性（P<.01）更有可能选择心理治疗。在治疗寻求和非选择（即非治疗寻求）样本中，心理治疗的偏好始终是明显的（两者均为 P<.001），但在非选择样本中稍强一些。
在不同环境中对患者偏好的综合分析得出了对心理治疗的显著 3 倍偏好。鉴于那些接受他们首选的精神科治疗的患者的结果有所改善，以及心理治疗的利用率呈下降趋势，需要采取策略最大程度地将患者与首选治疗相联系。
