TY - JOUR
T1 - Effectiveness of the DECIDE interventions on shared decision making and perceived quality of care in behavioral health with multicultural patients a randomized clinical trial
AU - Alegria, Margarita
AU - Nakash, Ora
AU - Johnson, Kirsten
AU - Ault-Brutus, Andrea
AU - Carson, Nicholas
AU - Fillbrunn, Mirko
AU - Wang, Ye
AU - Cheng, Alice
AU - Harris, Treniece
AU - Polo, Antonio
AU - Lincoln, Alisa
AU - Freeman, Elmer
AU - Bostdorf, Benjamin
AU - Rosenbaum, Marcos
AU - Epelbaum, Claudia
AU - LaRoche, Martin
AU - Okpokwasili-Johnson, Ebele
AU - Carrasco, Ma Jose
AU - Shrout, Patrick E.
N1 - Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/4
Y1 - 2018/4
N2 - IMPORTANCE Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care. OBJECTIVE To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample. DESIGN, SETTING, AND PARTICIPANTS This cross-level 2 × 2 randomized clinical trial included clinicians at level 2 and patients (nested within clinicians) at level 1 from 13 Massachusetts behavioral health clinics. Clinicians and patients were randomly selected at each site in a 1:1 ratio for each 2-person block. Clinicians were recruited starting September 1, 2013; patients, starting November 3, 2013. Final data were collected on September 30, 2016. Data were analyzed based on intention to treat. INTERVENTIONS The clinician intervention consisted of a workshop and as many as 6 coaching telephone calls to promote communication and therapeutic alliance to improve SDM. The 3-session patient intervention sought to improve SDM and quality of care. MAIN OUTCOMESAND MEASURES The SDM was assessedby a blinded coder based onclinical recordings, patient perception of SDM and quality of care, and clinician perception of SDM. RESULTS Of 312 randomized patients, 212 (67.9%) were female and 100 (32.1%) were male; mean (SD) age was 44.0 (15.0) years. Of 74 randomized clinicians, 56 (75.7%) were female and 18 (4.3%) were male; mean (SD) age was 39.8 (12.5) years. Patient-clinician pairs were assigned to 1 of the following 4 design arms: patient and clinician in the control condition (n = 72), patient in intervention and clinician in the control condition (n = 68), patient in the control condition and clinician in intervention (n = 83), or patient and clinician in intervention (n = 89). All pairs underwent analysis. The clinician intervention significantly increased SDM as rated by blinded coders using the 12-item Observing Patient Involvement in Shared Decision Making instrument (b = 4.52; SE = 2.17; P =.04; Cohen d = 0.29) but not as assessed by clinician or patient. More clinician coaching sessions (dosage) were significantly associated with increased SDM as rated by blinded coders (b = 12.01; SE = 3.72; P =.001; Cohen d = 0.78). The patient intervention significantly increased patient-perceived quality of care (b = 2.27; SE = 1.16; P =.05; Cohen d = 0.19). There was a significant interaction between patient and clinician dosage (b = 7.40; SE = 3.56; P =.04; Cohen d = 0.62), with the greatest benefit when both obtained the recommended dosage. CONCLUSIONS AND RELEVANCE The clinician intervention could improve SDM with minority populations, and the patient intervention could augment patient-reported quality of care.
AB - IMPORTANCE Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care. OBJECTIVE To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample. DESIGN, SETTING, AND PARTICIPANTS This cross-level 2 × 2 randomized clinical trial included clinicians at level 2 and patients (nested within clinicians) at level 1 from 13 Massachusetts behavioral health clinics. Clinicians and patients were randomly selected at each site in a 1:1 ratio for each 2-person block. Clinicians were recruited starting September 1, 2013; patients, starting November 3, 2013. Final data were collected on September 30, 2016. Data were analyzed based on intention to treat. INTERVENTIONS The clinician intervention consisted of a workshop and as many as 6 coaching telephone calls to promote communication and therapeutic alliance to improve SDM. The 3-session patient intervention sought to improve SDM and quality of care. MAIN OUTCOMESAND MEASURES The SDM was assessedby a blinded coder based onclinical recordings, patient perception of SDM and quality of care, and clinician perception of SDM. RESULTS Of 312 randomized patients, 212 (67.9%) were female and 100 (32.1%) were male; mean (SD) age was 44.0 (15.0) years. Of 74 randomized clinicians, 56 (75.7%) were female and 18 (4.3%) were male; mean (SD) age was 39.8 (12.5) years. Patient-clinician pairs were assigned to 1 of the following 4 design arms: patient and clinician in the control condition (n = 72), patient in intervention and clinician in the control condition (n = 68), patient in the control condition and clinician in intervention (n = 83), or patient and clinician in intervention (n = 89). All pairs underwent analysis. The clinician intervention significantly increased SDM as rated by blinded coders using the 12-item Observing Patient Involvement in Shared Decision Making instrument (b = 4.52; SE = 2.17; P =.04; Cohen d = 0.29) but not as assessed by clinician or patient. More clinician coaching sessions (dosage) were significantly associated with increased SDM as rated by blinded coders (b = 12.01; SE = 3.72; P =.001; Cohen d = 0.78). The patient intervention significantly increased patient-perceived quality of care (b = 2.27; SE = 1.16; P =.05; Cohen d = 0.19). There was a significant interaction between patient and clinician dosage (b = 7.40; SE = 3.56; P =.04; Cohen d = 0.62), with the greatest benefit when both obtained the recommended dosage. CONCLUSIONS AND RELEVANCE The clinician intervention could improve SDM with minority populations, and the patient intervention could augment patient-reported quality of care.
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U2 - 10.1001/jamapsychiatry.2017.4585
DO - 10.1001/jamapsychiatry.2017.4585
M3 - Article
C2 - 29466533
AN - SCOPUS:85045018266
SN - 2168-622X
VL - 75
SP - 325
EP - 335
JO - JAMA Psychiatry
JF - JAMA Psychiatry
IS - 4
ER -