Examining the effectiveness of a shared decision making intervention for antipsychotic medications to improve engagement in treatment for people experiencing early psychosis

检查抗精神病药物共同决策干预的有效性，以提高早期精神病患者的治疗参与度

• 批准号: 10670896
• 负责人: LISA B. DIXON
• 金额: $ 23.47万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670896
• 关键词: Accreditation; Address; Adherence; Adopted; American Psychiatric Association; Antipsychotic Agents; Attitude; Behavior Therapy; Benefits and Risks; Caring; Chronic Disease; Clinic; Clinical; Clinical Trials; Communication; Communities; Coordinated Specialty Care; Data; Data Collection; Decision Aid; Decision Making; Deterioration; Development; Distal; Early Intervention; Early treatment; Effectiveness; Emergency department visit; Environment; Goals; Healthcare Systems; Hospitalization; Individual; Infrastructure; International; Intervention; Interview; Investigational Therapies; Knowledge; Learning; Medication Management; Modeling; Modernization; National Institute of Mental Health; New York; Outcome; Participant; Patients; Pennsylvania; Persons; Pharmaceutical Preparations; Philosophy; Pilot Projects; Practice Guidelines; Process; Protocols documentation; Provider; Psychiatric therapeutic procedure; Psychiatrist; Psychiatry; Psychoses; Quality of Care; Randomized; Recommendation; Recovery; Research; Research Design; Sample Size; Schizophrenia; Site; Standardization; Symptoms; Testing; Therapeutic; Time; Training; Trust; Uncertainty; United States National Institutes of Health; Visit; Work; arm; comparison intervention; early experience; early psychosis; effectiveness evaluation; effectiveness study; effectiveness testing; effectiveness trial; evidence base; expectation; first episode psychosis; health communication; high risk; improved; intervention program; patient-clinician communication; personalized medicine; pilot test; pilot trial; premature; programs; psychiatric symptom; public health priorities; relapse risk; shared decision making; side effect; treatment as usual; treatment guidelines; treatment program; usability

Project Summary Shared decision making (SDM) is a process that involves open discussion between patient and clinician with the goal of improving treatment engagement and quality of care. Cumulative research as well as the recent edition of the American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia recognize the need for SDM when making decisions about antipsychotic medication (APM) and identify the lack of SDM in psychiatric care as a factor contributing to inconsistent APM use. The high rates of premature treatment discontinuation and inconsistent use of APM among individuals with first episode psychosis (FEP), who are at high risk for relapse and clinical deterioration, make SDM a public health priority. SDM is considered by the NIMH to be a framework within a coordinated specialty care (CSC) treatment model for FEP to improve care and engagement. Yet, to date, there is a gap between recommendations for using SDM and its actual use in psychiatric visits. In addition, evidence-based SDM interventions for APM decisions in psychiatry, especially in early psychosis care, are lacking, and the mechanism of SDM is yet to be defined. To fill these gaps, our project provides the first evidence-based SDM intervention for making decisions about APM within a FEP CSC treatment model. We will further develop our existing SDM intervention for psychosis, the Antipsychotic Medication Decision Aid (APM-DA), which was developed according to the highest International Patient Decision Aid Standards (IPDAS) and quality criteria. We hypothesize that the use of the APM-DA intervention in psychiatric visits focused on APM management for FEP will improve SDM targets (trust in the clinician, active participation in APM decisions, knowledge of APM and FEP), which will produce improved SDM proximal (level of SDM, program engagement, consistent use of APM) and distal outcomes (positive recovery attitudes, less severe symptoms over time, fewer ED visits and hospitalizations). This pilot effectiveness trial has two aims. In Aim 1, we will develop a delivery protocol and training materials for using the APM-DA in psychiatric visits in a large CSC program, OnTrackNY. Step 1 involves a qualitative formative study to develop the protocol and training materials (25 interviews), and Step 2 involves an open pilot trial of the protocol and training materials for final refinement with 20 patient participants. In Aim 2, we will conduct a cluster RCT at 6 CSC clinics with 120 patient participants (60 in each arm) to test potential mechanism/targets and impact of the APM-DA intervention compared with treatment as usual. Successful completion will result in an evidence-based SDM intervention that addresses an NIMH strategic goal to improve the quality of APM management for individuals with psychosis. Upon completion, a larger APM-DA clinical trial will be conducted via a subsequent R01.

项目摘要 共享决策（SDM）是一个过程，涉及患者和临床医生之间的公开讨论 改善治疗参与和护理质量的目的。累积研究以及最近的 美国精神病学协会练习指南，以治疗患者 精神分裂症在做出抗精神病药（APM）和 确定缺乏精神病护理中的SDM是导致APM使用不一致的因素。高率 过早的治疗中断和不一致的APM在第一事件中 患有复发和临床恶化的高风险的精神病（FEP）使SDM成为公共卫生的优先事项。 NIMH认为SDM是协调专业护理（CSC）治疗模型中的框架 为了改善护理和参与度。但是，到目前为止，使用的建议之间存在差距 SDM及其在精神病访问中的实际使用。此外，基于证据的SDM干预APM决策 在精神病学中，尤其是在早期精神病护理中，缺乏精神病学，而SDM的机制尚未定义。 为了填补这些空白，我们的项目提供了第一个基于证据的SDM干预措施，以做出决定 FEP CSC治疗模型中的APM。我们将进一步发展现有的SDM精神病干预措施， 根据最高 国际患者决策标准（IPDA）和质量标准。我们假设使用 APM-DA干预精神病访问的重点是APM管理FEP，将改善SDM目标 （信任临床医生，积极参与APM决策，对APM和FEP的知识），这将产生 改进的SDM近端（SDM级别，程序参与度，一致使用APM）和远端结果 （积极的恢复态度，随着时间的推移症状不那么严重，较少的ED就诊和住院治疗）。这个飞行员 有效试验有两个目标。在AIM 1中，我们将开发用于使用的交付协议和培训材料 大型CSC计划的精神病访问中的APM-DA，Ontrackny。步骤1涉及定性形成性 开发协议和培训材料的研究（25次访谈），第2步涉及 与20名患者参与者最终完善的协议和培训材料。在AIM 2中，我们将进行 在6个CSC诊所的簇RCT，有120名患者参与者（每个手臂中有60个），以测试潜在的机制/目标 与治疗相比，APM-DA干预的影响和影响。成功完成将导致 基于证据的SDM干预措施，该干预旨在提高APM质量的NIMH战略目标 精神病患者的管理。完成后，将进行较大的APM-DA临床试验 通过随后的R01。

项目成果

Disparities in Shared Decision-Making Research and Practice: The Case for Black American Patients.

共同决策研究和实践的差异：美国黑人患者的案例。

• DOI: 10.1370/afm.2943
• 发表时间: 2023
• 期刊: Annals of family medicine
• 影响因子: 4.4
• 作者: Zisman-Ilani,Yaara;Khaikin,Shely;Savoy,MargotL;Paranjape,Anuradha;Rubin,DanielJ;Jacob,Regina;Wieringa,ThomasH;Suarez,John;Liu,Jin;Gardiner,Heather;Bass,SarahBauerle;Montori,VictorM;Siminoff,LauraA
• 通讯作者: Siminoff,LauraA

Peer support and shared decision making in Open Dialogue: Opportunities and recommendations.

• DOI: 10.3389/fpsyg.2022.1059412
• 发表时间: 2022
• 期刊: FRONTIERS IN PSYCHOLOGY
• 影响因子: 3.8
• 作者: Chmielowska, Marta;Mannocci, Nell;Tansel, Alexander;Zisman-Ilani, Yaara
• 通讯作者: Zisman-Ilani, Yaara

Promoting Social Prescribing in Psychiatry-Using Shared Decision-Making and Peer Support.

• DOI: 10.1001/jamapsychiatry.2023.0788
• 发表时间: 2023-08-01
• 期刊: JAMA PSYCHIATRY
• 影响因子: 25.8
• 作者: Zisman-Ilani, Yaara;Hayes, Daniel;Fancourt, Daisy
• 通讯作者: Fancourt, Daisy

Shared Decision Making and Peer Support: New Directions for Research and Practice.

• DOI: 10.1176/appi.ps.20220407
• 发表时间: 2023-04-01
• 期刊: PSYCHIATRIC SERVICES
• 影响因子: 3.8
• 作者: Zisman-Ilani, Yaara;Byrne, Louise
• 通讯作者: Byrne, Louise