Takaesu Yoshikazu, Aoki Yumi, Tomo Yui, Tsuboi Takashi, Ishii Miho, Imamura Yayoi, Tachimori Hisateru, Watanabe Koichiro
Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.
Front Psychiatry. 2022 Aug 12;13:967750. doi: 10.3389/fpsyt.2022.967750. eCollection 2022.
Although shared treatment decision-making with patients requires attention, it is not widely implemented, particularly in the field of psychiatry. The aim of this study was to assess whether a shared decision-making (SDM) training program for clinicians based on the major depressive disorder (MDD) guidelines improved the perceived involvement of the decision process for patients with MDD.
A multi-center cluster-randomized controlled intervention of a clinician training program based on the Japanese MDD guidelines using related decision aids compared to usual care was conducted among 56 clinicians from 23 institutions. A total of 124 patients with MDD were enrolled in this study. The primary outcomes were the scores of the Shared Decision Making-Questionnaire-9 (SDM-Q-9) and Decision Conflict Scale (DCS) after the first visit to the outpatient clinics. The secondary outcomes were patients' satisfaction, quality of life, trust in clinicians, and depressive symptoms. Additionally, we evaluated all the observed outcomes at the first and third months of follow-up.
The scores of the SDM-Q-9 in the SDM training program group were significantly higher than those in the control group at the first visit. However, no significant difference in the DCS scores was found between the two groups. There was no intervention effect for secondary outcomes and the outcomes at the first- and third-month follow-up visits.
The clinician training program based on the Japanese MDD guidelines can be useful for implementation of SDM. Additional research is needed to confirm the efficacy of this SDM training program.
[https://www.umin.ac.jp/], identifier [UMIN000034397].
尽管与患者共同进行治疗决策需要引起重视，但它并未得到广泛实施，尤其是在精神病学领域。本研究的目的是评估基于重度抑郁症（MDD）指南的临床医生共同决策（SDM）培训项目是否能提高MDD患者在决策过程中的参与感。
在来自23家机构的56名临床医生中，开展了一项多中心整群随机对照干预研究，将基于日本MDD指南并使用相关决策辅助工具的临床医生培训项目与常规护理进行比较。本研究共纳入124例MDD患者。主要结局指标为首次门诊就诊后共同决策问卷-9（SDM-Q-9）和决策冲突量表（DCS）的得分。次要结局指标包括患者满意度、生活质量、对临床医生的信任度以及抑郁症状。此外，我们在随访的第一个月和第三个月评估了所有观察到的结局。
在首次就诊时，SDM培训项目组的SDM-Q-9得分显著高于对照组。然而，两组之间的DCS得分没有显著差异。次要结局指标以及第一个月和第三个月随访时的结局指标均未发现干预效果。
基于日本MDD指南的临床医生培训项目可能有助于SDM的实施。需要进一步的研究来证实该SDM培训项目的疗效。
