title: Valuation and attainment of treatment goals in schizophrenia:  perspectives of patients, relatives, physicians, and payers.
abstract: OBJECTIVE
  This study investigated and compared the valuation and perceived attainment of multiple treatment goals in schizophrenia from the perspectives of four different groups of stakeholders.
  
  
  METHODS
  Twenty treatment goals (identified in a qualitative patient-based pre-study) were ranked and rated according to their relevance in standardized interviews. Goal attainment was also rated. A rank correlation was computed to identify congruencies among the stakeholder groups. A hierarchical cluster analysis of the data from the stakeholders groups was also conducted.
  
  
  RESULTS
  In this study, 105 outpatients, 160 physicians, 50 relatives, and 30 payers were interviewed. All goals were considered very relevant by all stakeholder groups. "Improved cognitive abilities" was ranked among the top three goals by patients, physicians, and relatives, while "reduced disease-related symptoms" was ranked first by relatives and second by physicians. Payers gave the highest priority to goals that were more likely to affect costs (i.e., ability to resume work, reduced disease-related symptoms, less hospitalization/ need for outpatient visits). Pairwise agreement rates ranged from 38.9% to 63.3%. Rank correlations were found between relatives and patients (r=0.51; P=0.002), relatives and physicians (r=0.43; P=0.008), and payers and patients (r=0.43; P=0.008). The cluster analysis revealed a relevant congruency among patients, relatives, and physicians. Goal attainment was rated lower than goal relevance by all groups, with patients judging attainment the best on average, followed by relatives, physicians, and payers. Reduction in disease-related symptoms was rated as the goal that was best achieved.
  
  
  CONCLUSIONS
  Discordances among the groups with respect to their valuation of treatment goals should encourage stakeholders to better understand others' preferences as a prerequisite for improved shared decision making and potentially improved treatment outcomes.
authors.affiliation: University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany. o.kuhnigk@uke.de
authors.forename: Olaf
authors.initials: O
authors.lastname: Kuhnigk
authors.forename: Lara
authors.initials: L
authors.lastname: Slawik
authors.forename: Jelka
authors.initials: J
authors.lastname: Meyer
authors.forename: Dieter
authors.initials: D
authors.lastname: Naber
authors.forename: Jens
authors.initials: J
authors.lastname: Reimer
mesh_terms: D016000:Cluster Analysis; D005190:Family / Q000523:psychology; D005260:Female; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D012559:Schizophrenia / Q000628:therapy*; D016896:Treatment Outcome