Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany.
Isar-Amper-Klinikum München Ost, Haar, Germany.
Epidemiol Psychiatr Sci. 2020 Jun 16;29:e137. doi: 10.1017/S2045796020000505.
AIMS: Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM-PLUS). METHODS: The study is a multi-centre, cluster-randomised, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of five psychiatric hospitals addressing inpatients with schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under 'treatment as usual' conditions. The primary outcome parameter was the patients' perceived involvement in decision-making at 3 weeks after study enrolment, analysed using a random-effects linear regression model. RESULTS: In total, 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision-making (primary outcome, analysed patients n = 257, mean group difference 16.5, 95% CI 9.0-24.0, p = 0.002, adjusted for baseline differences: β 17.3, 95% CI 10.8-23.6, p = 0.0004). In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalisation rates in the 6- and 12-month follow-up. CONCLUSIONS: Despite limitations in patient recruitment, the SDM-PLUS trial has shown that the adoption of behavioural approaches (e.g. motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment.Trial registration: The trial was registered at Deutsches Register Klinischer Studien (DRKS00010880).
目的：尽管共享决策（SDM）有可能改善健康结果，但精神科医生经常将病情更严重或更急性的患者排除在治疗决策之外。本研究旨在检验一种特别适用于急性病患者的方法（SDM-PLUS）是否能促进 SDM。
方法：这是一项多中心、集群随机、非盲、对照试验，在五家精神病医院的 12 个急性精神病病房中，对符合纳入标准的精神分裂症或分裂情感障碍的住院患者进行了研究。所有符合纳入标准的患者在入院时均连续纳入试验。干预病房的治疗团队通过参加两个半天的研讨会接受 SDM-PLUS 方法的培训。干预病房的患者接受 SDM 小组培训。对照组病房的工作人员（和患者）在“常规治疗”条件下进行治疗。主要结局参数是患者在研究入组后 3 周时对决策的感知参与度，使用随机效应线性回归模型进行分析。
结果：干预组和对照组各招募了 161 名参与者。SDM-PLUS 可显著提高患者对决策的感知参与度（主要结局，分析患者 n = 257，平均组间差异 16.5，95%CI 9.0-24.0，p = 0.002，调整基线差异后：β 17.3，95%CI 10.8-23.6，p = 0.0004）。此外，干预组患者在住院期间表现出更好的治疗联盟、治疗满意度和自我评估的药物依从性。然而，在 6 个月和 12 个月的随访中，治疗依从性和再住院率并没有显著提高。
结论：尽管患者招募存在局限性，但 SDM-PLUS 试验表明，采用行为方法（如动机访谈）进行 SDM 可能会成功应用于精神健康。作者建议采取策略，以确保在门诊和住院治疗之间不会失去效果。
试验注册：该试验在德国临床试验注册中心（DRKS00010880）注册。
Eur Psychiatry. 2020-9-28
Soc Psychiatry Psychiatr Epidemiol. 2017-2
Cochrane Database Syst Rev. 2022-11-11
Patient Prefer Adherence. 2022-9-1
Front Psychiatry. 2019-7-4
Psychiatr Serv. 2019-2-20
Eur Psychiatry. 2018-8-15
Soc Psychiatry Psychiatr Epidemiol. 2017-2
Soc Psychiatry Psychiatr Epidemiol. 2016-4
Psychiatr Serv. 2014-12-1
Zotero 插件