The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial.
OBJECTIVE
Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process. Additional research is needed to test the effect of increased patient participation on outcomes. The aim of this study was to assess, if patient participation in decision-making via a shared decision-making intervention leads to improved treatment adherence, satisfaction, and clinical outcome without increasing consultation time.


METHODS
Cluster-randomized controlled intervention study based on physician training and patient-centered decision aid compared to usual care in primary care settings in Südbaden region of Germany. Twenty-three primary care physicians treating 405 patients with newly diagnosed depression were enrolled. Patient involvement was measured with the patient perceived involvement in care scale (PICS) and a patient participation scale (MSH-scale). Patient satisfaction was measured by the CSQ-8 questionnaire. Treatment adherence was evaluated by patient and provider self-report. Depression severity and remission outcomes were assessed with the Brief PHQ-D.


RESULTS
Physician facilitation of patient participation improved significantly and to a greater extent in the intervention compared to the control group. There was no intervention effect for depression severity reduction. Doctor facilitation of patient participation, patient-rated involvement, and physician assessment of adherence improved only in the intervention group. Patient satisfaction at post-intervention was higher in the intervention group compared to the control group. The consultation time did not differ between groups.


CONCLUSIONS
A shared decision-making intervention was better than usual care for improving patient participation in treatment decision-making, and patient satisfaction without increasing consultation time. Additional research is needed to model causal linkages in the decision-making process in regard to outcomes.


CONCLUSIONS
The study results encourage the implementation of patient participation in primary care of depression.
Loh
Andreas
A
University Hospital of Freiburg, Department of Psychiatry and Psychotherapy, Section Clinical Epidemiology and Health Services Research, Freiburg, Germany. Andreas.Loh@uniklinik-freiburg.de
Simon
Daniela
D
Wills
Celia E
CE
Kriston
Levente
L
Niebling
Wilhelm
W
Härter
Martin
M
D000328:Adult; D000704:Analysis of Variance; D016000:Cluster Analysis; D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000458:organization & administration / Q000523:psychology; D011320:Primary Health Care / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors