Implementing patient-centered decision support for mental health

描述（由申请人提供）：背景/理由：重要的是，严重精神疾病患者有机会获得符合他们偏好的治疗，并在替代治疗中做出明智的选择。通常情况下，患者的偏好并没有被常规地引出，也没有被用来指导哪些治疗方法是可用的。精神分裂症是一种常见的严重精神疾病，如果治疗不当，会导致严重的残疾。国家治疗指南明确指出，精神分裂症患者应接受循证心理治疗，以改善预后。例如，肥胖在这一人群中是一个紧迫的问题，是常用药物的副作用，也是心血管疾病和过早死亡的原因之一。体重管理有多种不同的心理治疗方法，可以导致体重减轻。没有一种被广泛使用。如果对病人的偏好进行常规评估，那么临床医生和管理人员就会知道何时提供替代治疗，以及为哪些病人提供替代治疗。目的：本项目实施并评估一种常规评估精神分裂症患者治疗偏好的方法。目标是：1)开发一个计算机化的、基于信息亭的系统，向患者提供有关体重治疗方案的教育，使用联合分析来得出患者的偏好，并满足精神分裂症患者的认知需求；2)研究该方法在精神卫生诊所实施的可行性和可接受性；并且，3)评估该方法预测基于证据的权重服务使用的程度，以及三个月后对服务的满意度。方法：对精神分裂症患者的偏好、治疗使用和满意度进行前瞻性评估。94名超重患者在繁忙的城市心理健康诊所接受治疗。这些参与者使用一个信息亭系统，向他们提供有关治疗方案的教育，并评估他们对超重替代治疗方案的偏好。然后，他们每周接受一次以证据为基础的强化心理治疗。研究评估在基线和3个月进行。对治疗偏好进行分析，以确定它们与体重治疗的使用和治疗满意度之间的关系。意义：患有严重精神疾病的人可以从获得有效的心理治疗中受益。通过定期收集有关个体患者偏好的信息，将有助于实施这些治疗方法。如果本研究的评估方法是可行的、可接受的和准确的，它可以用于支持在诊所、医疗中心和社区项目中实施改进的护理。

DESCRIPTION (provided by applicant): Background/Rationale: It is important that patients with serious mental illness have access to treatments that meet their preferences, and make informed choices among alternative treatments. Too often, preferences are not being routinely elicited from patients, nor used to guide which treatments are made available. Schizophrenia is a serious mental illness that is common and can produce substantial disability when poorly treated. National treatment guidelines specify that patients with schizophrenia should receive evidence-based psychosocial treatments that improve outcomes. For example, obesity is a pressing problem in this population, a side-effect of commonly used medications, and a cause of cardiovascular disease and premature mortality. There are multiple, different psychosocial treatments for weight management that can lead to reduced weight. None are widely used. If patient preferences were routinely assessed, then clinicians and managers would know when to make alternative treatments available, and for which patients. Objectives: This project implements and evaluates a method for routinely assessing the treatment preferences of patients with schizophrenia. The objectives are to: 1) develop a computerized, kiosk-based system that delivers patient education regarding treatment options for weight, uses conjoint analysis to elicit patient preferences, and meets the cognitive needs of individuals with schizophrenia; 2) study the feasibility and acceptability of implementing this method at a mental health clinic; and, 3) evaluate the extent to which this method predicts use of an evidence-based weight service, and satisfaction with the service at three months. Methods: This is a prospective evaluation of preferences, treatment use, and satisfaction in patients with schizophrenia. 94 patients are enrolled who are overweight and receiving treatment at a busy, urban mental health clinic. These participants use a kiosk system that provides them with education about treatment options, and assesses their preferences regarding alternative treatments for overweight. They are then offered a weekly, intensive, evidence-based psychosocial treatment for weight. Research assessments occur at baseline and 3 months. Treatment preferences are analyzed to determine how they relate to use of weight treatment, and satisfaction with treatment. Significance: People with serious mental illness could benefit from access to effective psychosocial treatments. Implementing these treatments would be facilitated by routinely collecting information regarding individual patients' preferences. If the assessment method in this study is found to be feasible, acceptable, and accurate, it could be used to support implementation of improved care at clinics, medical centers, and community-based programs.