Loos Sabine, Clarke Eleanor, Jordan Harriet, Puschner Bernd, Fiorillo Andrea, Luciano Mario, Ivánka Tibor, Magyar Erzsébet, Krogsgaard-Bording Malene, Østermark-Sørensen Helle, Rössler Wulf, Kawohl Wolfram, Mayer Benjamin, Slade Mike
Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany.
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
BMC Psychiatry. 2017 Jan 23;17(1):38. doi: 10.1186/s12888-017-1207-4.
Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery.
Data derived from an observational cohort study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR). Adults (aged 18-60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change.
Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15-2.94) or passive (OR = 1.71, 95% CI = 1.00-2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery.
Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
临床决策是提供医疗服务的载体，参与程度可预测实施情况和满意度。本研究旨在调查决策经验对康复的影响。
数据源自一项观察性队列研究“重度精神疾病患者常规护理中的临床决策与结果”（CEDAR）。从六个欧洲国家的门诊和社区精神卫生服务病例中招募符合重度精神疾病标准化标准的成年人（年龄18 - 60岁）。在获得同意后，他们在基线和1年后使用标准化的决策、临床结果和康复阶段测量方法进行评估。采用潜在类别分析来确定康复过程，并用比例优势模型来研究康复阶段和变化的预测因素。
参与者（n = 581）在基线时分为三个康复阶段：暂停期（N = 115；19.8%）､意识/准备期（N = 145；25.0%）和重建/成长期（N = 321；55.2%）。较高阶段在横断面分析中与男性、已婚、独自生活或与父母同住、患者评价的治疗联盟更好以及症状较少相关。该模型解释了康复阶段40%的方差。与共同参与（OR = 1.84，95% CI 1.15 - 2.94）或被动参与（OR = 1.71，95% CI = 1.00 - 2.95）相比，积极参与的患者出现更差结果（1年内康复阶段降低）的可能性增加。总体而言，过程（治疗关系）和结果（症状学）在横断面分析中均与康复阶段相关。
患者评价的决策参与度与康复阶段的变化相关。患者和临床医生在康复过程中共同考虑决策实践应该是改善临床实践的有用策略（ISRCTN注册库：ISRCTN75841675。2010年9月15日追溯注册）。
