Hamann Johannes, Parchmann Anna, Sassenberg Nina, Bronner Katharina, Albus Margot, Richter Alwin, Hoppstock Sandra, Kissling Werner
Psychiatric Department, Technische Universität München, Munich, Germany.
Isar Amper Klinikum München Ost, Haar, Germany.
Soc Psychiatry Psychiatr Epidemiol. 2017 Feb;52(2):175-182. doi: 10.1007/s00127-016-1327-z. Epub 2016 Dec 31.
Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients' communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence.
Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient-doctor interaction such as question asking or giving feedback.
N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients' participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists' estimate) their behavior in psychiatric consultations.
While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients' active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.
许多精神分裂症患者希望参与共同决策（SDM）。然而，在临床实践中，共同决策往往并未实现。一个原因可能是许多患者在医疗问诊中表现被动，因此不利于共同决策的开展。本研究旨在评估针对患者的共同决策培训对患者在会诊中的沟通行为、其对决策的态度以及长期依从性的影响。
随机对照试验，比较为精神分裂症住院患者开展的为期五节的共同决策培训与为期五节的非特异性团体培训。共同决策培训课程包括动机方面（如参与的前景、患者权利）和行为方面（如角色扮演），并涉及患者与医生互动的重要方面，如提问或给予反馈。
在德国的四家精神病医院招募了N = 264名患者。共同决策培训在出院后6个月和12个月时，在主要结局指标（治疗依从性）方面未产生组间差异。然而，对患者的参与偏好、其承担更多医疗决策责任的意愿以及（根据其精神科医生的估计）他们在精神科会诊中的行为产生了短期影响。
虽然在治疗依从性方面没有效果，但已证明针对精神分裂症住院患者的共同决策培训可增加患者在住院治疗期间精神科会诊中的积极行为。实施时应与补充性的共同决策干预措施（决策支持工具和针对专业人员的沟通培训）相结合，以产生最大效果。
