Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): study protocol.
BACKGROUND
A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness.


METHODS
The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome.


CONCLUSIONS
The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe.


BACKGROUND
ISRCTN75841675.
Department of Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str 2, 89312 Günzburg, Germany. bernd.puschner@bkh-guenzburg.de
Bernd
B
Puschner
Sabine
S
Steffen
Mike
M
Slade
Helena
H
Kaliniecka
Mario
M
Maj
Andrea
A
Fiorillo
Povl
P
Munk-Jørgensen
Jens Ivar
JI
Larsen
Anikó
A
Egerházi
Zoltan
Z
Nemes
Wulf
W
Rössler
Wolfram
W
Kawohl
Thomas
T
Becker
D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D003657:Decision Making; D005060:Europe; D005062:European Union; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D008960:Models, Psychological; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D010358:Patient Participation; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D016896:Treatment Outcome