Improving Collaborative Decision Making in Veterans with Serious Mental Illness

改善患有严重精神疾病的退伍军人的协作决策

• 批准号: 10400016
• 负责人: Emily Treichler
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400016
• 关键词: Accounting; Acute; Address; Administrator; Adult; Appointment; Attitude; Award; Behavior; Budgets; Caring; Chronic; Communication; Data; Decision Making; Development; Disease remission; Effectiveness; Ensure; Family; Feedback; Frequencies; Future; Goals; Health; Health Services Accessibility; Hearing; Hour; Impairment; Individual; Intervention; Manuals; Mental Health; Mentors; Methods; Modification; Motivation; Outcome; Outcome Measure; Outpatients; Participant; Patient Preferences; Patients; Personal Satisfaction; Persons; Phase; Pilot Projects; Play; Post-Traumatic Stress Disorders; Process; Provider; Quality of life; Randomized; Randomized Clinical Trials; Recommendation; Recovery; Rehabilitation therapy; Research; Research Design; Research Personnel; Role; Schools; Self Efficacy; Service delivery model; Services; Severities; Social Functioning; Symptoms; Treatment outcome; United States Department of Veterans Affairs; Veterans; Voice; Work; active control; arm; base; behavioral health; chronic pain; cognitive skill; collaborative trial; design; disability; disability impact; empowered; evidence base; experience; follow-up; functional outcomes; implementation science; improved; improved functioning; improved outcome; open label; post intervention; preference; primary outcome; psychosocial rehabilitation; randomized trial; reduce symptoms; rehabilitation service; satisfaction; secondary outcome; service delivery; severe mental illness; skills; skills training; social skills; stakeholder perspectives; success; treatment as usual; trial comparing

Recovery-oriented care is an imperative for the VA, particularly in mental health programming for Veterans with serious mental illness (SMI). Collaborative decision-making (CDM) is a recovery-oriented approach to treatment decision-making that assigns equal participation and obligation to patients and providers across all aspects of decision-making, thereby empowering patients and facilitating better decision-making based on patient values and preferences. CDM is associated with several important outcomes including improved treatment engagement, treatment satisfaction, and social functioning. However, current levels of CDM among Veterans with SMI are low, and there is not yet an evidence-based method to improve CDM. Improving Veteran skill sets associated with engaging in CDM is a potential intervention strategy. Collaborative Decision Skills Training (CDST) is a promising new intervention that was previously developed by the applicant for use in adult civilians with SMI and found to improve relevant skills and improve sense of personal recovery. The proposed study has two primary stages. First, a small, one-armed, open label trial will establish CDST's feasibility will evaluate CDST among 12 Veterans with SMI receiving services at the VA San Diego Psychosocial Rehabilitation and Recovery Center (PRRC) and identify and complete any needed adaptations to CDST. Stakeholder feedback from Veterans, VA clinicians, and VA administrators will be collected to assess Veteran needs and service context to identify any needed adaptations to the CDST manual or the delivery of CDST to maximize its impact and feasibility. The developers of CDST (the applicant and Dr. William Spaulding, a consultant) will review all feedback and make final decisions about adaptations to ensure that CDST retains its essential components to protect against loss of efficacy. For example, a recommendation to adjust role-play topics to better reflect the needs of Veterans would be accepted because it would increase CDST's relevance without impairing its integrity, but a recommendation to remove all role-plays would not be accepted because it would cause loss of a key component. Second, CDST will be compared to active control (AC) using a randomized clinical trial of 72 Veterans. The primary outcome measure will be functioning within the rehabilitation context, operationalized as frequency of Veteran CDM behaviors during Veteran-provider interactions. Secondary outcomes are treatment attendance, engagement, satisfaction, and motivation, along with treatment outcomes (i.e., rehabilitation goal attainment, sense of personal recovery, symptom severity, and social functioning). Three exploratory outcomes will be assessed: Veteran-initiated collaborative behaviors, acute service use and provider attitudes and behavior. Veterans will be randomly assigned to CDST or AC conditions. Veterans in the both groups will attend eight hour-long group sessions held over eight weeks. All Veterans will complete an assessment battery at baseline, post-intervention, and at three-month post-intervention follow-up. Following the trial and adaptation phase, the findings will be used to develop a CDST service delivery manual and design a logical subsequent study. The results of the proposed study will inform the potential for larger trials of CDST and the utility of providing CDST broadly to Veterans with SMI. The results of this study will expand current understanding of CDM among Veterans with SMI by providing data that will: 1) identify adaptations needed to optimize CDST for Veterans receiving services in PRRCs; 2) identify possible benefits of CDST; 3) inform development of alternate interventions or methods to improve CDM; and 4) further elucidate CDM and associated treatment processes among Veterans with SMI receiving VA rehabilitation services.

以康复为导向的护理对于退伍军人管理局来说是当务之急，特别是在为退伍军人提供心理健康规划方面 严重精神疾病（SMI）。协作决策 (CDM) 是一种以恢复为导向的方法 为所有患者和提供者分配平等参与和义务的治疗决策 决策的各个方面，从而赋予患者权力并促进基于 患者的价值观和偏好。 CDM 与多项重要成果相关，包括改善 治疗参与度、治疗满意度和社会功能。然而，目前的 CDM 水平 患有SMI的退伍军人比例较低，目前还没有基于证据的方法来改善CDM。改善 与参与 CDM 相关的资深技能是一种潜在的干预策略。协同决策 技能培训（CDST）是一种有前景的新干预措施，由申请人之前开发使用 在患有 SMI 的成年平民中进行研究，发现可以提高相关技能并改善个人康复感。 拟议的研究有两个主要阶段。首先，一项小型、单臂、开放标签试验将建立 CDST 可行性将评估 12 名在 VA San Diego 接受 SMI 服务的退伍军人的 CDST 心理社会康复中心 (PRRC) 并确定并完成任何所需的适应 到CDST。将收集退伍军人、退伍军人事务部临床医生和退伍军人管理局管理人员的利益相关者反馈以进行评估 退伍军人需求和服务背景，以确定对 CDST 手册或交付的任何必要调整 CDST 最大限度地发挥其影响和可行性。 CDST的开发者（申请人和William Spaulding博士， 顾问）将审查所有反馈并做出有关调整的最终决定，以确保 CDST 保留 其重要成分可防止功效丧失。例如，调整角色扮演的建议 更好地反映退伍军人需求的主题将被接受，因为这将增加 CDST 的相关性 在不损害其完整性的情况下，但删除所有角色扮演的建议不会被接受，因为 会造成关键部件的损失。 其次，将使用 72 名退伍军人的随机临床试验将 CDST 与主动对照 (AC) 进行比较。这 主要成果衡量标准将在康复背景下发挥作用，具体化为康复频率 退伍军人与提供者互动期间的退伍军人 CDM 行为。次要结果是治疗出勤率、 参与度、满意度和动机，以及治疗结果（即康复目标的实现、 个人康复感、症状严重程度和社会功能）。三个探索性成果将是 评估：退伍军人发起的协作行为、敏锐的服务使用以及提供者的态度和行为。 退伍军人将被随机分配到 CDST 或 AC 条件。两组退伍军人都将参加八场 为期一小时的小组会议持续了八周。所有退伍军人都将完成基线评估， 干预后以及干预后三个月的随访。经过试验和适应阶段后， 研究结果将用于制定 CDST 服务提供手册并设计合理的后续研究。 拟议研究的结果将为 CDST 进行更大规模试验的潜力以及提供的效用提供信息 CDST 广泛适用于患有 SMI 的退伍军人。这项研究的结果将扩大目前对清洁发展机制的理解 通过提供以下数据，在患有 SMI 的退伍军人中进行：1) 确定优化 CDST 所需的适应措施 在 PRRC 接受服务的退伍军人； 2) 确定 CDST 可能带来的好处； 3）通知开发 改进清洁发展机制的替代干预措施或方法； 4) 进一步阐明 CDM 和相关治疗 接受 VA 康复服务的 SMI 退伍军人的流程。