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      A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation

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          Abstract

          Background

          Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes.

          Objective

          This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders.

          Methods

          The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation.

          Results

          In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F 1,68=0.422, P=.52; COMRADE confidence in decision: F 1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams.

          Conclusions

          The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate.

          Trial Registration

          Dutch Trial Register (NTR) trial number: 10340; http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=10340 (Archived by WebCite at http://www.webcitation.org/6Jj5umAeS).

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          Most cited references26

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            An 18-item version of the Client Satisfaction Questionnaire (CSQ-18) was included in an experimental study of the effects of pretherapy orientation on psychotherapy outcome. The psychometric properties of the CSQ-18 in this study were compared with earlier findings. In addition, the correlations of the CSQ-18 with service utilization and psychotherapy outcome measures were examined. Results indicated that the CSQ-18 had high internal consistency (coefficient alpha = .91) and was substantially correlated with remainer-terminator status (rs = .61) and with number of therapy sessions attended in one month (r = .54). The CSQ-18 was also correlated with change in client-reported symptoms (r = -.35), indicating that greater satisfaction was associated with greater symptom reduction. Results also demonstrated that a subset of items from the scale (the CSQ-8) performed as well as the CSQ-18 and often better. The excellent performance of the CSQ-8, coupled with its brevity, suggests that it may be especially useful as a brief global measure of client satisfaction.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                October 2013
                07 October 2013
                : 15
                : 10
                : e216
                Affiliations
                [1] 1University of Groningen University Medical Center University Center for Psychiatry GroningenNetherlands
                [2] 2University of Groningen Johann Bernoulli Institute for Mathematics and Computer Science GroningenNetherlands
                [3] 3Friesland Mental Health Care Service LeeuwardenNetherlands
                Author notes
                Corresponding Author: Lian van der Krieke j.a.j.van.der.krieke@ 123456umcg.nl
                Article
                v15i10e216
                10.2196/jmir.2851
                3806550
                24100091
                9171045e-7355-4f0b-8eb5-747ed9f9b66d
                ©Lian van der Krieke, Ando C Emerencia, Nynke Boonstra, Lex Wunderink, Peter de Jonge, Sjoerd Sytema. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.10.2013.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 26 July 2013
                : 16 August 2013
                : 29 August 2013
                : 15 September 2013
                Categories
                Original Paper

                Medicine
                psychotic disorders, schizophrenia,computers,computer-assisted decision making,shared decision making,feasibility studies, randomized clinical trial

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