Exploring the Mechanisms of a Patient-Centred Assessment with a Solution Focused Approach (DIALOG+) in the Community Treatment of Patients with Psychosis: A Process Evaluation within a Cluster-Randomised Controlled Trial.
Exploring the Mechanisms of a Patient-Centred Assessment with a Solution Focused Approach (DIALOG+) in the Community Treatment of Patients with Psychosis: A Process Evaluation within a Cluster-Randomised Controlled Trial.
复制标题
DOI：
10.1371/journal.pone.0148415
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Priebe S
中科院分区：
文献类型：
--
作者：
Omer S;Golden E;Priebe S
DIALOG+是一种新的干预措施，使常规的社区心理健康会议具有治疗效果。它涉及对患者问题的结构化评估和以解决方案为中心的方法来解决这些问题。在一项随机对照试验中，DIALOG+与精神病患者更好的主观生活质量和其他结局相关，但尚不清楚这是如何实现的。本研究探讨了可能的机制。这是一项随机分组对照试验中的混合方法过程评价。焦点小组和访谈进行了与患者和临床医生谁经历了DIALOG+，并使用主题分析进行了分析。DIALOG+会议的内容根据（一）会议期间商定的行动类型和（二）讨论的领域进行了记录和分析。使用混合效应模型分析主观生活质量指标，以探索DIALOG+的影响是否仅限于在会话中解决的生活领域或在所有领域中一致。关于DIALOG+的机制，出现了四个定性主题：（1）全面的结构;（2）自我反思;（3）治疗性自我表达;（4）赋权。患者对会议期间同意的大多数行动负责（65%）。治疗对主观生活质量的影响最大的是生活状况（住宿和与患者一起生活的人）和心理健康。其中两个领域是DIALOG+会议中最常讨论的三个领域之一（住宿，心理健康和身体健康）。DIALOG+在会议中讨论的领域发起积极的、特定领域的变革。它为例行会议提供了一个全面和以解决方案为重点的结构，鼓励自我反思和表达，并赋予患者权力。未来的研究应加强和监测这些因素。ISRCTN登记研究ISRCTN 34757603。
DIALOG+ is a new intervention to make routine community mental health meetings therapeutically effective. It involves a structured assessment of patient concerns and a solution-focused approach to address them. In a randomised controlled trial, DIALOG+ was associated with better subjective quality of life and other outcomes in patients with psychosis, but it was not clear how this was achieved. This study explored the possible mechanisms. This was a mixed-methods process evaluation within a cluster-randomised controlled trial. Focus groups and interviews were conducted with patients and clinicians who experienced DIALOG+ and were analysed using thematic analysis. The content of DIALOG+ sessions was recorded and analysed according to (i) the type of actions agreed during sessions and (ii) the domains discussed. The subjective quality of life measure was analysed with mixed-effects models to explore whether the effect of DIALOG+ was limited to life domains that had been addressed in sessions or consistent across all domains. Four qualitative themes emerged regarding the mechanisms of DIALOG+: (1) a comprehensive structure; (2) self-reflection; (3) therapeutic self-expression; and (4) empowerment. Patients took responsibility for the majority of actions agreed during sessions (65%). The treatment effect on subjective quality of life was largest for living situation (accommodation and people that the patient lives with) and mental health. Two of these domains were among the three most commonly discussed in DIALOG+ sessions (accommodation, mental health, and physical health). DIALOG+ initiates positive, domain-specific change in the areas that are addressed in sessions. It provides a comprehensive and solution-focused structure to routine meetings, encourages self-reflection and expression, and empowers patients. Future research should strengthen and monitor these factors. ISRCTN Registry ISRCTN34757603.