Krause Karolin R, Hetrick Sarah E, Courtney Darren B, Cost Katherine Tombeau, Butcher Nancy J, Offringa Martin, Monga Suneeta, Henderson Joanna, Szatmari Peter
Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
Lancet Psychiatry. 2022 Dec;9(12):992-998. doi: 10.1016/S2215-0366(22)00338-8.
To make decisions in mental health care, service users, clinicians, and administrators need to make sense of research findings. Unfortunately, study results are often presented as raw questionnaire scores at different time points and regression coefficients, which are difficult to interpret with regards to their clinical meaning. Other commonly reported treatment outcome indicators in clinical trials or meta-analyses do not convey whether a given change score would make a noticeable difference to service users. There is an urgent need to improve the interpretability and relevance of outcome indicators in youth mental health (aged 12-24 years), in which shared decision making and person-centred care are cornerstones of an ongoing global transformation of care. In this Personal View, we make a case for considering minimally important change (MIC) as a meaningful, accessible, and user-centred outcome indicator. We discuss what the MIC represents, how it is calculated, and how it can be implemented in dialogues between clinician and researcher, and between youth and clinician. We outline how use of the MIC could enhance reporting in clinical trials, meta-analyses, clinical practice guidelines, and measurement-based care. Finally, we identify current methodological challenges around estimating the MIC and areas for future research. Efforts to select outcome domains and valid measurement instruments that resonate with youth, families, and clinicians have increased in the past 5 years. In this context, now is the time to define demarcations of changes in outcome scores that are clinically relevant, and meaningful to youth and families. Through the use of MIC, youth-centred outcome measurement, analysis, and reporting would support youth-centred therapeutic decision making.
为了在精神卫生保健中做出决策，服务使用者、临床医生和管理人员需要理解研究结果。不幸的是，研究结果通常以不同时间点的原始问卷分数和回归系数呈现，就其临床意义而言，这些很难解释。临床试验或荟萃分析中其他常见报告的治疗结果指标并未表明给定的变化分数是否会对服务使用者产生显著差异。迫切需要提高青少年精神卫生（12至24岁）结果指标的可解释性和相关性，其中共同决策和以患者为中心的护理是全球正在进行的护理转型的基石。在这篇个人观点文章中，我们主张将最小重要变化（MIC）视为一个有意义、易懂且以用户为中心的结果指标。我们讨论了MIC代表什么、如何计算以及如何在临床医生与研究人员之间以及青少年与临床医生之间的对话中实施。我们概述了使用MIC如何能加强在临床试验、荟萃分析、临床实践指南和基于测量的护理中的报告。最后，我们确定了当前围绕估计MIC的方法学挑战以及未来研究的领域。在过去5年里，选择与青少年、家庭和临床医生产生共鸣的结果领域和有效测量工具的努力有所增加。在此背景下，现在是时候定义在临床上相关且对青少年和家庭有意义的结果分数变化界限了。通过使用MIC，以青少年为中心的结果测量、分析和报告将支持以青少年为中心的治疗决策。
