Department of Psychology.
J Consult Clin Psychol. 2022 Jan;90(1):90-106. doi: 10.1037/ccp0000642. Epub 2021 Jun 24.
Thus far, most applications in precision mental health have not been evaluated prospectively. This article presents the results of a prospective randomized-controlled trial investigating the effects of a digital decision support and feedback system, which includes two components of patient-specific recommendations: (a) a clinical strategy recommendation and (b) adaptive recommendations for patients at risk for treatment failure.
Therapist-patient dyads ( = 538) in a cognitive behavioral therapy outpatient clinic were randomized to either having access to a decision support system (intervention group; = 335) or not (treatment as usual; = 203). First, treatment strategy recommendations (problem-solving, motivation-oriented, or a mix of both strategies) for the first 10 sessions were evaluated. Second, the effect of psychometric feedback enhanced with clinical problem-solving tools on treatment outcome was investigated.
The prospective evaluation showed a differential effect size of about 0.3 when therapists followed the recommended treatment strategy in the first 10 sessions. Moreover, the linear mixed models revealed therapist symptom awareness and therapist attitude and confidence as significant predictors of an outcome as well as therapist-rated usefulness of feedback as a significant moderator of the feedback-outcome and the not on track-outcome associations. However, no main effects were found for feedback.
The results demonstrate the importance of prospective studies and the high-quality implementation of digital decision support tools in clinical practice. Therapists seem to be able to learn from such systems and incorporate them into their clinical practice to enhance patient outcomes, but only when implementation is successful. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
到目前为止，大多数精准心理健康应用尚未进行前瞻性评估。本文介绍了一项前瞻性随机对照试验的结果，该试验研究了数字决策支持和反馈系统的效果，该系统包括患者特定建议的两个组成部分：（a）临床策略建议和（b）针对治疗失败风险患者的适应性建议。
认知行为疗法门诊的治疗师-患者二人组（n=538）被随机分为使用决策支持系统组（干预组，n=335）或不使用组（常规治疗，n=203）。首先，评估前 10 次治疗中针对患者的治疗策略建议（解决问题、以动机为导向或混合策略）。其次，研究了通过临床问题解决工具增强的心理计量反馈对治疗结果的影响。
前瞻性评估显示，在头 10 次治疗中治疗师遵循推荐的治疗策略时，效果差异的效应量约为 0.3。此外，线性混合模型显示，治疗师的症状意识、治疗师的态度和信心是治疗结果的显著预测因素，以及治疗师对反馈有用性的评价是反馈-结果和未按计划治疗结果关联的显著调节因素。然而，未发现反馈的主要影响。
结果表明前瞻性研究和数字决策支持工具在临床实践中的高质量实施的重要性。治疗师似乎能够从这些系统中学习并将其纳入临床实践中，以提高患者的治疗效果，但前提是实施成功。（PsycInfo 数据库记录（c）2022 APA，保留所有权利）。
