Treichler Emily B H, Rabin Borsika A, Spaulding William D, Thomas Michael L, Salyers Michelle P, Granholm Eric L, Cohen Amy N, Light Gregory A
VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA.
Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA.
Pilot Feasibility Stud. 2021 Mar 29;7(1):89. doi: 10.1186/s40814-021-00820-4.
Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans.
In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran's Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness.
This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field's understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs.
ClinicalTrials.gov Identifier: NCT04324944.
共同决策是一种创新的决策方法，赋予患者和医疗服务提供者平等的权力和责任。大多数患有精神分裂症等严重精神疾病的退伍军人希望在治疗决策中发挥更大作用，但目前尚无针对这一人群的干预措施。基于技能的干预措施很有前景，因为它与康复模式高度契合，采用了与该人群其他循证干预措施类似的机制，并且可以在不同决策背景下推广，同时使退伍军人有能力决定何时启动共同决策。共同决策技能培训（CDST）是在患有严重精神疾病的普通人群样本中开发的，可能填补这一空白，但需要经过系统的调整过程以确保适用于退伍军人。
在目标1中，将使用IM Adapt系统流程对患有严重精神疾病的退伍军人调整CDST。退伍军人和退伍军人事务部（VA）工作人员将加入一个调整资源团队，并完成定性访谈，以确定CDST的要素或服务提供方式可能需要如何调整，以优化其对退伍军人和VA环境的有效性或可行性。在目标2中，将在VA心理社会康复与恢复中心（PRRC）对退伍军人进行开放试验，以评估进一步的调整、可行性和有效性的初步证据。
本研究将首次评估针对患有严重精神疾病的退伍军人的共同决策干预措施。它还将有助于该领域了解患有严重精神疾病的退伍军人和VA临床医生对共同决策的看法，并产生一份服务提供手册，可用于总体了解VA PRRC中的调整需求。
ClinicalTrials.gov标识符：NCT04324944。
