A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial...

Area of Science:

• Psychiatry and Mental Health
• Health Informatics
• Patient Engagement

Background:

• Policy initiatives promote electronic decision aids to enhance patient participation in healthcare.
• Evidence is needed to validate the effectiveness of these tools in clinical settings, particularly for improving patient involvement and outcomes.

Purpose of the Study:

• To evaluate a Web-based intervention designed to facilitate shared decision-making among patients with psychotic disorders through a randomized controlled trial.
• To conduct a process evaluation of the intervention's implementation and impact on patient involvement.

Main Methods:

• A randomized controlled trial was conducted in a Dutch mental health institution with 250 patients with psychosis (first episode and chronic).
• The intervention group (n=124) received access to a Web-based decision tool, while the control group (n=126) received usual care.
• Patient-perceived involvement in decision-making was the primary outcome, measured by the COMRADE scale. Process evaluation included surveys, interviews, and observations.

Main Results:

• Only 38.7% of patients accessed the Web-based decision aid, with most utilizing its full features.
• No significant differences were observed in perceived involvement in medical decision-making between the intervention and control groups.
• Process evaluation indicated that the intervention was not optimally integrated into routine clinical practice.

Conclusions:

• While many patients with psychotic disorders, including those with first-episode or chronic conditions, can engage with electronic decision aids, this study did not demonstrate increased patient involvement.
• Potential reasons for the lack of significant findings include suboptimal implementation and a low participant response rate.
• Further research is needed to optimize the integration and effectiveness of electronic decision aids in mental healthcare.