A Smartphone App to Promote Patient Activation and Support Shared Decision-making in People With a Diagnosis of Schizophrenia in Outpatient Treatment Settings (Momentum Trial): Randomized Controlled Assessor-Blinded Trial

被引:9
|
作者
Vitger, Tobias [1 ,2 ]
Hjorthoj, Carsten [3 ,4 ]
Austin, Stephen F. [5 ]
Petersen, Lone [1 ]
Tonder, Esben Sandvik [6 ]
Nordentoft, Merete [2 ,3 ]
Korsbek, Lisa [7 ]
机构
[1] Mental Hlth Serv Capital Reg Denmark, Competence Ctr Rehabil & Recovery, Mental Hlth Ctr Ballerup, Maglevaenget 19, DK-2750 Ballerup, Denmark
[2] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark
[3] Copenhagen Univ Hosp, Copenhagen Res Ctr Mental Hlth, Mental Hlth Ctr Copenhagen, CORE, Copenhagen, Denmark
[4] Univ Copenhagen, Dept Publ Hlth, Sect Epidemiol, Copenhagen, Denmark
[5] Psychiat Res Unit, Psychiat Reg Zealand, Slagelse, Denmark
[6] Mental Hlth Serv Zealand, Slagelse, Denmark
[7] Mental Hlth Serv Reg Southern Denmark, Mental Hlth Ctr Odense, Odense, Denmark
关键词
mobile health; mHealth; digital intervention; shared decision-making; patient activation; schizophrenia; schizotypal; early intervention; randomized clinical trial; mobile phone; VALIDATION; DIMENSIONS; EFFICACY; SYMPTOM; SCALE;
D O I
10.2196/40292
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of accessibility, structure, and reminders. Objective: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to support patient activation and SDM. Methods: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia, schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance, satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the intervention at the midintervention time point along with objective data on the use of the digital tool were collected. Results: In total, 194 participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one's provider (mean difference 1.85, 95% CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use of antipsychotic medicine, and number or length of psychiatric hospital admissions. Conclusions: This trial showed a significant effect of a digital SDM tool on the subjective level of patient activation, confidence in communicating with one's provider, and feeling prepared for decision-making at the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes to the evidence on how digital tools may support patient-centered care and SDM in mental health care.
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页数:17
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