Implementing patient-centered decision support for mental health

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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.