Metz M J, Veerbeek M A, Elfeddali I, de Beurs E, van der Feltz-Cornelis C M, Beekman A T F
Tijdschr Psychiatr. 2019;61(7):487-497.
Although the evidence is expanding, in mental health care shared decision making (SDM) is not widely applied. Moreover, little is known about the use of routine outcome monitoring (ROM) and eHealth in SDM.
AIM: PhD research on the added value of SDM using ROM and eHealth for patients and clinicians in mental health care.
METHOD: Three studies: 1. a literature research and a cross-sectional study on decisional conflict; 2. ROM implementation research and a cluster randomised trial on shared decision making using ROM (Breakthrough program); 3. a cluster randomised trial on shared decision making during the intake (regional).
RESULTS: The interventions did not lead to reduced decisional conflict for all patient groups. Decisional conflict gives insight into the patient's perspective on the quality of the decision making process and decisions being made. Only patients with depression, who participated in the national trial, reported less decisional conflict. This trial did not show a higher level of SDM, but did show increased usage of rom in clinical practice. Although the regional trial showed no results on decisional conflict, the application of SDM and treatment outcomes improved.
CONCLUSION: SDM in mental health care needs further improvement. We recommend investigating how to support patients better, taking into account the role that suits them.
尽管相关证据不断增加,但在精神卫生保健中,共同决策(SDM)并未得到广泛应用。此外,对于常规结果监测(ROM)和电子健康在共同决策中的应用知之甚少。
开展博士研究,探讨在精神卫生保健中使用ROM和电子健康对患者和临床医生而言共同决策的附加价值。
三项研究:1. 一项关于决策冲突的文献研究和横断面研究;2. ROM实施研究以及一项关于使用ROM进行共同决策的整群随机试验(突破计划);3. 一项关于 intake 期间共同决策的整群随机试验(区域性)。
干预措施并未使所有患者群体的决策冲突减少。决策冲突能让我们了解患者对决策过程和所做决策质量的看法。只有参与全国性试验的抑郁症患者报告的决策冲突较少。该试验未显示出更高水平的共同决策,但确实显示出临床实践中ROM的使用有所增加。尽管区域性试验在决策冲突方面未得出结果,但共同决策的应用和治疗效果有所改善。
精神卫生保健中的共同决策需要进一步改进。我们建议研究如何更好地支持患者,同时考虑适合他们的角色。