Psychiatric and Mental Health Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
Department of Neuropsychiatry, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
Psychiatry Res. 2019 Nov;281:112531. doi: 10.1016/j.psychres.2019.112531. Epub 2019 Aug 30.
Providing appropriate treatment to patients with a first episode of mood disorders is crucial for recovery from the disorders. Although shared decision making (SDM) has been proposed as a promising model in psychiatric practice, an appropriate SDM approach has not yet been established. The aim of the current study was to evaluate the effects of an originally developed seven-day SDM program for outpatients with a first episode of mood disorders among university students. University students with a first episode of mood disorders were randomly allocated into two arms: SDM and control. The participants in the SDM arm received the seven-day SDM program, which included option presentation consultation, external deliberation with a decision aid booklet, decision coaching by a nurse, and decision-making consultation. The control arm received usual care. The primary outcome was patient-perceived involvement. We enrolled 88 participants. Compared with usual care, the SDM program significantly improved patient-perceived involvement in treatment decision making without taking up clinicians' time. The program did not lead to worse symptoms of mood disorders. In conclusion, sharing treatment decision making with university students with a first episode of mood disorders is feasible.
为首次发作心境障碍的患者提供适当的治疗对于其疾病康复至关重要。尽管共享决策（SDM）已被提议作为精神科实践中的一种有前途的模式，但尚未建立适当的 SDM 方法。本研究的目的是评估为大学生首发心境障碍患者开发的为期七天的 SDM 方案对门诊患者的影响。首发心境障碍的大学生被随机分配到 SDM 和对照组两个组。SDM 组的参与者接受了为期七天的 SDM 方案，其中包括选择呈现咨询、使用决策辅助手册进行外部协商、由护士进行决策指导以及决策咨询。对照组接受常规护理。主要结局是患者感知的参与度。我们共纳入了 88 名参与者。与常规护理相比，SDM 方案在不占用临床医生时间的情况下，显著提高了患者对治疗决策的感知参与度，且不会导致心境障碍症状恶化。总之，与首发心境障碍的大学生共享治疗决策是可行的。
