Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making: A cluster randomised controlled trial in a specialist mental health outpatient setting

Margot Metz; Iman Elfeddali; Marjolein Veerbeek; Edwin de Beurs; Aartjan Beekman; Christina van der Feltz-Cornelis

doi:10.1371/journal.pone.0199795

Effectiveness of a multi-facetted blended eHealth intervention during intake supporting patients and clinicians in Shared Decision Making: A cluster randomised controlled trial in a specialist mental health outpatient setting

PLoS One. 2018 Jun 26;13(6):e0199795. doi: 10.1371/journal.pone.0199795. eCollection 2018.

Authors

Margot Metz^{1

2

3}, Iman Elfeddali^{1

4}, Marjolein Veerbeek², Edwin de Beurs^{5

6}, Aartjan Beekman^{7

8}, Christina van der Feltz-Cornelis^{1

4}

Affiliations

¹ GGz Breburg, Tilburg, The Netherlands.
² Trimbos Institute, Utrecht, The Netherlands.
³ VU University, EMGO, Amsterdam, The Netherlands.
⁴ Tilburg University, Tranzo Department, Tilburg, The Netherlands.
⁵ Foundation for Benchmarking Mental Health Care, Bilthoven, The Netherlands.
⁶ University of Leiden, Department of Clinical Psychology, Leiden, The Netherlands.
⁷ GGZ inGeest, Amsterdam, The Netherlands.
⁸ VU University Medical Centre, Department of Psychiatry, Amsterdam, The Netherlands.

Abstract

Objective: To investigate the effectiveness of a multi-facetted blended eHealth intervention, called SDM-Digital Intake (SDM-DI), in which patients and clinicians are supported in Shared Decision Making during the intake process.

Methods: The study is a two-arm matched-paired cluster Randomised Controlled Trial in a specialist mental health outpatient setting with two conditions: SDM-DI and Intake As Usual (IAU). Four intake teams were allocated to each arm. All patients who followed an intake, were asked to participate if they were capable to complete questionnaires. Decisional Conflict (DC), referring to patients' engagement and satisfaction with clinical decisions, was the primary outcome. Secondary outcomes were patient participation, applying Shared Decision Making (SDM), working alliance, treatment adherence and symptom severity. Effects were measured at two weeks (T1) and two months (T2) after intake. Multilevel regression and intention-to-treat analyses were used. Additionally, the influence of subgroups and intervention adherence on DC were explored.

Results: At T1, 200 patients participated (47% intervention, 53% control), and at T2 175 patients (47% intervention, 53% control). At T1 and T2, no differences were found between conditions on DC. Subgroup analyses showed that effects of SDM-DI on DC were not modified by primary diagnoses mood, anxiety and personality disorders. Compared to IAU, at T2, patients reported positive effects of SDM-DI on SDM (β 7.553, p = 0.038, 95%CI:0.403-14.703, d = 0.32) and reduction of symptoms (β -7.276, p = 0.0497, 95%CI:-14.544--0.008, d = -0.43). No effects were found on patient participation, working alliance and treatment adherence. Exploratory analyses demonstrated that if SDM was applied well, patients reported less DC (β = -0.457, p = 0.000, 95%CI:-0.518--0.396, d = -1.31), which was associated with better treatment outcomes.

Conclusion: Although, this trial fails to demonstrate that SDM-DI by itself is sufficient to reduce DC, the results are encouraging for further efforts in improving and implementing the SDM intervention.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ambulatory Care / methods*
Decision Making*
Female
Humans
Male
Mental Disorders* / psychology
Mental Disorders* / therapy
Mental Health*
Middle Aged
Patient Compliance*
Surveys and Questionnaires*
Telemedicine*

Grants and funding

This trial was funded by GGz Breburg, specialist mental health organisation in the southern part of the Netherlands. GGz Breburg (www.ggzbreburg.nl) contributed time and resources to the development and implementation of this intervention and evaluation study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.