scholarly journals Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

2015 ◽  
Vol 25 (1) ◽  
pp. 69-79 ◽  
Author(s):  
B. Puschner ◽  
T. Becker ◽  
B. Mayer ◽  
H. Jordan ◽  
M. Maj ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Primary Outcome ◽  
Clinical Decision Making ◽  
Unmet Needs ◽  
Clinical Decision ◽  
Routine Care ◽  
Shared Decision ◽  
Over Time

Aims.Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.Methods.“Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness” (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.Results.Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ2 = 135.08; p < 0.001) and staff (χ2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (−0.406 unmet needs per two months, p = 0.007) or shared (−0.303 unmet needs per two months, p = 0.015) decision making.Conclusions.Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.

Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): first results

2011 ◽  
Vol 38 (S 01) ◽  
Author(s):  
E Ay ◽  
M Frøkjær Krogsgaard Bording ◽  
T Ivánka ◽  
D Giacco ◽  
A Bär ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care ◽  
First Results

scholarly journals Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR): Study protocol

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Bernd Puschner ◽  
Sabine Steffen ◽  
Mike Slade ◽  
Helena Kaliniecka ◽  
Mario Maj ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Study Protocol ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care

What Patients With Severe Mental Illness Transitioning From Hospital to Community Have to Say About Care and Shared Decision-Making

2016 ◽  
Vol 37 (6) ◽  
pp. 400-405 ◽  
Author(s):  
Dawn I. Velligan ◽  
David L. Roberts ◽  
Cynthia Sierra ◽  
Megan M. Fredrick ◽  
Mary Jo Roach
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Shared Decision Making ◽  
Shared Decision

scholarly journals Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units

2014 ◽  
Vol 11 (02) ◽  
pp. 105-118 ◽  
Author(s):  
Karleen Gwinner ◽  
Louise Ward
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Intensive Care ◽  
Lived Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Review Of Literature ◽  
Psychiatric Distress ◽  
Nurse Knowledge

AbstractBackground and aimIn recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.MethodData gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.ResultsFour defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.ConclusionThe four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

scholarly journals QOLP-03. MEASURING CHANGE IN HEALTH-RELATED QUALITY OF LIFE: THE ADDED VALUE OF ANALYSIS ON THE INDIVIDUAL PATIENT LEVEL IN GLIOMA PATIENTS IN CLINICAL DECISION MAKING

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi197-vi198 ◽  
Author(s):  
Marijke Coomans ◽  
Martin Taphoorn ◽  
Neil Aaronson ◽  
Brigitta Baumert ◽  
Martin van den Bent ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Scale Item ◽  
Individual Patient Level ◽  
Patient Level ◽  
Related Quality ◽  
The Individual ◽  
The Impact ◽  
Over Time

Abstract BACKGROUND: Health-related quality of life (HRQoL) is an important outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to study whether different methods to evaluate change in HRQoL result in different interpretations. Methods: HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed: (1)at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2)at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3)at the individual patient level combining all scales/items. Results: Data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p< .001, range in change score:0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range:27–84%), many patients deteriorated (range:6–43%) or improved (range:8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Conclusion: Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes may help patients and physicians to make the best treatment decision.

scholarly journals OS7.2 Measuring change in health-related quality of life: the added value of analysis on the individual patient level in glioma patients in clinical decision making

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii14-iii14
Author(s):  
M Coomans ◽  
M J B Taphoorn ◽  
N Aaronson ◽  
B G Baumert ◽  
M van den Bent ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Scale Item ◽  
Individual Patient Level ◽  
Patient Level ◽  
Related Quality ◽  
The Individual ◽  
The Impact ◽  
Over Time

Abstract BACKGROUND Health-related quality of life (HRQoL) is often used as an outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores may provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to examine three different methods to evaluate change in HRQoL, and to study whether these methods result in different interpretations. MATERIAL AND METHODS HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed in three ways: (1) at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2) at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3) at the individual patient level combining all scales/items. RESULTS Baseline and first follow-up HRQoL data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p<.001, range in change score: 0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range 27–84%), many patients deteriorated (range: 6–43%) or improved (range: 8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Clustering on clinical characteristics (WHO performance status, sex, tumor type, type of resection, newly diagnosed versus recurrent tumor and age) did not identify subgroups of patients with a specific pattern of change in their HRQoL score. CONCLUSION Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes, showing that most patients experience both deterioration and improvement, may help patients and physicians to make the best treatment decision.

Shared Decision-Making Preferences of People With Severe Mental Illness

2007 ◽  
Vol 58 (9) ◽  
pp. 1219-1221 ◽  
Author(s):  
Jared R. Adams ◽  
Robert E. Drake ◽  
George L. Wolford
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Shared Decision Making ◽  
Shared Decision
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