title: Mental Health Providers' Decision-Making Around the Implementation of Evidence-Based Treatment for PTSD.
abstract: It is estimated that <15% of veterans with posttraumatic stress disorder (PTSD) have engaged in two evidence-based psychotherapies highly recommended by VA-cognitive processing therapy (CPT) and prolonged exposure (PE). CPT and PE guidelines specify which patients are appropriate, but research suggests that providers may be more selective than the guidelines. In addition, PTSD clinical guidelines encourage "shared decision-making," but there is little research on what processes providers use to make decisions about CPT/PE. Sixteen licensed psychologists and social workers from two VA medical centers working with ≥1 patient with PTSD were interviewed about patient factors considered and decision-making processes for CPT/PE use. Qualitative analyses revealed that patient readiness and comorbid conditions influenced decisions to use or refer patients with PTSD for CPT/PE. Providers reported mentally derived and instances of patient-involved decision-making around CPT/PE use. Continued efforts to assist providers in making informed and collaborative decisions about CPT/PE use are discussed.
authors.affiliation: Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN, 55417, USA. Princess.Osei-Bonsu@va.gov.|Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA. Princess.Osei-Bonsu@va.gov.|Department of Medicine, University of Minnesota, Minneapolis, MA, USA. Princess.Osei-Bonsu@va.gov.
authors.forename: Princess E
authors.initials: PE
authors.lastname: Osei-Bonsu
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road (152), Bedford, MA, 01730, USA.
authors.forename: Rendelle E
authors.initials: RE
authors.lastname: Bolton
authors.affiliation: Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, CA, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey Stirman
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Eisen
authors.affiliation: Mental Health Service Line, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Herz
authors.affiliation: Mental Health Service Line, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: Maura E
authors.initials: ME
authors.lastname: Pellowe
mesh_terms: D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology