GGz Breburg, Tilburg, The Netherlands.
Trimbos Institute, Utrecht, The Netherlands.
PLoS One. 2018 Jun 26;13(6):e0199795. doi: 10.1371/journal.pone.0199795. eCollection 2018.
To investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process.
The study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored.
At T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (β 7.553, p = 0.038, 95%CI:0.403-14.703, d = 0.32) and reduction of symptoms (β -7.276, p = 0.0497, 95%CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (β = -0.457, p = 0.000, 95%CI:-0.518--0.396, d = -1.31), which was associated with better treatment outcomes.
Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.
调查一种多方面混合电子健康干预措施（称为 SDM-Digital Intake，SDM-DI）的有效性，该措施在患者和临床医生在摄入过程中共同做出决策时为其提供支持。
该研究是一项在精神科门诊专科环境中进行的两臂配对群组随机对照试验，分为两种情况：SDM-DI 和常规摄入量（IAU）。每个臂分配了四个摄入团队。所有接受摄入量的患者，如果能够完成问卷调查，则被要求参与。决策冲突（DC），是指患者对临床决策的参与度和满意度，是主要的结果。次要结果是患者参与度、共同决策（SDM）的应用、工作联盟、治疗依从性和症状严重程度。在摄入量后两周（T1）和两个月（T2）进行效果测量。使用多层次回归和意向治疗分析。此外，还探索了亚组和干预依从性对 DC 的影响。
在 T1 时，有 200 名患者参与（47%的干预组，53%的对照组），在 T2 时有 175 名患者参与（47%的干预组，53%的对照组）。在 T1 和 T2，条件之间在 DC 上未发现差异。亚组分析表明，SDM-DI 对 DC 的影响不受主要诊断（心境、焦虑和人格障碍）的影响。与 IAU 相比，在 T2，患者报告 SDM-DI 对 SDM 有积极影响（β 7.553，p = 0.038，95%CI：0.403-14.703，d = 0.32）和症状减轻（β-7.276，p = 0.0497，95%CI：-14.544--0.008，d = -0.43）。在患者参与度、工作联盟和治疗依从性方面没有发现效果。探索性分析表明，如果应用 SDM 良好，患者报告的 DC 较少（β = -0.457，p = 0.000，95%CI：-0.518--0.396，d = -1.31），这与更好的治疗结果相关。
尽管本试验未能证明 SDM-DI 本身足以降低 DC，但结果令人鼓舞，可进一步努力改进和实施 SDM 干预措施。
