Shared Decision-Making for Elderly Depressed Primary Care Patients

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DESCRIPTION (provided by applicant): Shared decision-making (SDM), in contrast to traditional medical decision-making, involves a collaborative process whereby patients articulate personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. SDM may be particularly relevant for depressed individuals, as it seeks to enhance their autonomy and empowerment in a manner that directly addresses the helplessness and hopelessness associated with depression. Shared decision-making interventions are being developed for depression in primary care, but have yet to be adequately tested. It is also unknown whether the same premises regarding shared decision-making's ability to enhance autonomy and empowerment pertain to elderly populations. The proposed study will evaluate the impact of a three-session SDM nursing intervention among depressed elderly primary care patients, in comparison to Usual Care (UC), on patient adherence to antidepressant medication or psychotherapy and on reduction in depressive symptoms. The focus of the SDM intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that can be successfully implemented. Based on our prior work that demonstrated the impact of patients' a priori treatment preferences on treatment initiation and adherence, we propose to conduct a randomized controlled trial of elderly depressed primary care patients to determine the impact of SDM on treatment adherence and reduction in depressive symptoms. The study randomizes 30 physicians from Lincoln Hospital in the Bronx, a large ethnically diverse primary care clinic, to either Shared Decision-Making (SDM) or the Usual Care (UC) comparison condition. A total of 210 depressed (PHQ-9>15) geriatric patients whose physicians' recommend starting depression treatment, will receive either SDM or UC according to physician randomization. Subjects will be assessed at baseline and at weeks 4, 8, 12, and 24 to determine treatment adherence and depressive status. If SDM is effective, it may serve as a brief independent intervention by practice nurses, and will provide a platform to tailor and disseminate the model throughout a variety of primary care practice settings and populations. PUBLIC HEALTH RELEVANCE: Shared decision-making, in contrast to traditional medical decision-making, involves a collaborative process whereby patients share personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. The proposed study will evaluate the impact of a shared decision- making nursing intervention among depressed elderly primary care patients on patient adherence to depression treatment and on improvement in depression. The focus of the intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that they can successfully implement.