Healthcare Options for People Experiencing Depression (HOPE∗D): The development and pilot testing of an encounter-based decision aid for use in primary care
mental health care
Attitude of Health Personnel
Decision Making, Shared
Decision Support Techniques
Patient Acceptance of Health Care
Primary Health Care
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/4561
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Abstract© © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To develop and pilot an encounter-based decision aid (eDA) for people with depression for use in primary care. Design We developed an eDA for depression through cognitive interviews and pilot tested it using a one-group pretest, post-Test design in primary care. Feasibility, fidelity of eDA use and acceptability were assessed using recruitment rates and semistructured interviews with patients, medical assistants and clinicians. Treatment choice and shared decision-making (SDM) were also assessed. Setting Interviews with adult patients and the public were conducted in a mall and library in Grafton County, New Hampshire, while clinician interviews took place by phone or at the clinician's office. Pilot testing occurred in a New Hampshire primary care practice. Participants Cognitive interviews were conducted with adults, ≥18 years, who could read English from the following stakeholder groups: history of depression, the public and clinicians. Patients with a Patient Health Questionnaire-9 score of ≥5 were recruited for piloting. Results Three stages of cognitive interviews were conducted (n=28). Changes to eDA included moving the combination therapy information and access to treatment information, adding colour, modifying pictograms and editing the talk-Therapy description. Clinician concerns about patient health literacy were not reflected in patient interviews. Of 59 patients who reviewed study information, 56 were eligible and agreed to participate in pilot testing; however, only 29 could be reached for follow-up. The eDA was widely accepted, though clinicians did not always use it as intended. We found no impact of eDA use on SDM, though patients chose a wider range of treatment options. Conclusions We demonstrated the feasibility of the use of an eDA for depression in primary care that was widely accepted. Further research is needed to improve the fidelity with which the eDA is used and to assess its impact on SDM and related health outcomes.
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Teacher education and its association with decision-making: An investigation of the classroom management decisions of incoming education majors, graduating education majors, and expert teachersByrnes, James P.; Woyshner, Christine A.; Farley, Frank; DuCette, Joseph P.; Smith, Michael W. (Michael William), 1954- (Temple University. Libraries, 2009)This study investigates the value of a teacher education program by comparing freshman education majors and senior education majors in their ability to make decisions about classroom management issues. Participants (N = 137) responded to a vignette style interview schedule and responses were coded and analyzed. Senior education majors were found to make significantly better decisions than freshman education majors and two groups of non-education students. Implications for improving and evaluating teacher education are discussed.
Evaluating the feasibility of a decision aid to promote shared decision making among young adults with first-episode psychosis: protocol for a pilot studyZisman-Ilani, Y; Hurford, I; Bowen, A; Salzer, M; Thomas, EC; Thomas, Elizabeth|0000-0001-6543-9856 (2021-12-01)© 2021, The Author(s). Background: Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. Methods: A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3- and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics. Discussion: This protocol outlines the methodology for a feasibility pilot comparing the effect of a novel SDM Antipsychotic Medication encounter DA with treatment as usual on SDM, medication adherence, and service engagement in FEP care. SDM is endorsed as a framework for use in FEP and antipsychotic pharmacotherapy, but its impact on adherence and health outcomes is unclear. Understanding the potential contribution of an SDM Antipsychotic Medication DA compared with usual care in psychosis pharmacotherapy is critical. The study will help answer several key questions new to SDM research, including the contribution of personality and clinical relationships to SDM in mental health and psychosis in particular. The study will serve to gather feasibility data to inform future studies and scale-up. Trial registration: Ethics approval was obtained through Temple University’s institutional review board (IRB) and the City of Philadelphia’s Department of Public Health IRB. The study has been retrospectively registered with ClinicalTrials.gov as NCT04373590 on 29 April 2020. https://clinicaltrials.gov/ct2/show/NCT04373590?term=NCT04373590&draw=2&rank=1
Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient PopulationMatthews, Elizabeth B.; Savoy, Margot; Paranjape, Anuradha; Washington, Diana; Hackney, Treanna; Galis, Danielle; Zisman-Ilani, Yaara; Zisman-Ilani|0000-0001-6852-2583 (2021-07-12)Objectives: Although depression is a significant public health issue, many individuals experiencing depressive symptoms are not effectively linked to treatment by their primary care provider, with underserved populations have disproportionately lower rates of engagement in depression care. Shared decision making (SDM) is an evidence-based health communication framework that can improve collaboration and optimize treatment for patients, but there is much unknown about how to translate SDM into primary care depression treatment among underserved communities. This study seeks to explore patients' experiences of SDM, and articulate communication and decision-making preferences among an underserved patient population receiving depression treatment in an urban, safety net primary care clinic. Methods: Twenty-seven patients with a depressive disorder completed a brief, quantitative survey and an in-depth semi-structured interview. Surveys measured patient demographics and their subjective experience of SDM. Qualitative interview probed for patients' communication preferences, including ideal decision-making processes around depression care. Interviews were transcribed verbatim and analyzed using thematic analysis. Univariate statistics report quantitative findings. Results: Overall qualitative and quantitative findings indicate high levels of SDM. Stigma related to depression negatively affected patients' initial attitude toward seeking treatment, and underscored the importance of patient-provider rapport. In terms of communication and decision-making preferences, patients preferred collaboration with doctors during the information sharing process, but desired control over the final, decisional outcome. Trust between patients and providers emerged as a critical precondition to effective SDM. Respondents highlighted several provider behaviors that helped facilitated such an optimal environment for SDM to occur. Conclusion: Underserved patients with depression preferred taking an active role in their depression care, but looked for providers as partner in this process. Due to the stigma of depression, effective SDM first requires primary care providers to ensure that they have created a safe and trusting environment where patients are able to discuss their depression openly.