Investigating Patient Acceptability of Stratified Medicine for Schizophrenia: A Mixed Methods Study

Health services have advocated a stratified medicine approach in mental health, but little is known about whether service users would accept this approach.

To explore service users' views of the acceptability of stratified medicine for treatment-resistant schizophrenia compared to the traditional "trial-and-error" approach.

A mixed methods observational study that explored questionnaire responses on acceptability and whether these responses were affected by demographic or clinical variables. We also investigated whether treatment responsiveness or experience of invasive tests (brain scans and blood tests) affected participants' responses. Questionnaire generated qualitative data were analyzed thematically. Participants (N108) were aged 18-65, had a diagnosis of schizophrenia, and were adherent to antipsychotic medication.

Acceptability of a stratified approach was high, even after participants had experienced invasive tests. Most rated it as safer (62% vs 43%; P < .01 [CI: -1.69 to 2.08]), less risky (77% vs 44%; P < .01 [CI: -1.75 to 1.10]), and less painful (90% vs 73%; P < 0.01 [CI: -0.84 to 0.5]) and this was not affected by treatment responsiveness or test experience. Although not statistically significant, treatment nonresponders were more willing to undergo invasive tests. Qualitatively, all participants raised concerns about the risks, discomfort, and potential side effects associated with the invasive tests.

Service users were positive about a stratified approach for choosing treatments but were wary of devolving clinical decisions to purely data-driven algorithms. These results reinforce the value of service user perspectives in the development and evaluation of novel treatment approaches.