Department of Psychology, University of Oslo.
Department of Counseling Psychology, University of Wisconsin-Madison.
Psychotherapy (Chic). 2018 Sep;55(3):241-254. doi: 10.1037/pst0000194.
A fundamental part of professional practice is to monitor case progress to inform basic clinical decisions about when to discontinue interventions, when to adjust interventions, and when to proceed as planned. When interpreting observed change, there are at least five distinct types of clinical difference that can occur independently, and mistaking one for another can lead to misinformed clinical decisions. We introduce a distinction between observed difference, detected difference, predicted difference, attainment difference, and induced difference, and use these to analyze current systems for routine outcome monitoring (ROM) in clinical practice. Contrary to what supporting evidence of current ROM systems suggests, we find that-by design-these systems fail to detect and predict potentially harmful treatment and fail to detect and predict likely treatment responders. We discuss implications of the presented classification for professional practice and further development of ROM systems. We argue that clinical practice would benefit from monitoring difference instead of change, as these are not equivalent. We further argue that future research and development efforts should focus on the development of a working approach to monitoring induced difference, improving how to monitor predicted difference, exploring statistical models that better discriminate between various types of clinical cases, and better communicate what can and cannot be interpreted from the clinical differences that are actually monitored, as guided by the presented classification of clinical differences to monitor in practice. (PsycINFO Database Record
专业实践的一个基本部分是监测病例进展，以便就何时停止干预、何时调整干预以及何时按计划进行提供基本的临床决策依据。在解释观察到的变化时，至少有五种不同类型的临床差异可以独立发生，如果将一种差异误认为另一种差异，可能会导致临床决策失误。我们引入了观察差异、检测差异、预测差异、实现差异和诱导差异之间的区别，并使用这些区别来分析当前临床实践中常规结果监测 (ROM) 的系统。与当前 ROM 系统的支持证据所表明的相反，我们发现——由于设计原因——这些系统无法检测和预测潜在的有害治疗，也无法检测和预测可能的治疗反应者。我们讨论了所提出的分类对专业实践和 ROM 系统进一步发展的影响。我们认为，与变化相比，监测差异而非变化将使临床实践受益，因为它们并不等同。我们进一步认为，未来的研究和开发工作应侧重于开发一种监测诱导差异的实用方法，改进如何监测预测差异，探索能够更好地区分各种类型临床病例的统计模型，并更好地传达从实际监测到的临床差异中可以解释什么和不能解释什么，正如所提出的临床差异监测分类所指导的那样。
