This study investigates the effect of clinical decision making (CDM) on outcome in people with severe mental illness in six European countries (Germany, UK, Italy, Hungary, Denmark, and Switzerland).
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.
During study preparation (Apr 09- Oct 09), specific instruments were developed and psychometric properties established to measure CDM style (CDMS), key elements of CDM in routine care (CDRC), as well as CDM involvement and satisfaction (CDIS) from patient and staff perspectives.
Recruitment for the main study was successfully completed in Dec 10, and the data base was closed one year later. A total of 588 patients met inclusion criteria and gave informed consent to participate. Participating patients were in there early 40s on average with a mean illness duration of 13 years. Main diagnoses were mostly psychotic disorders followed by mood and other mental disorders. Participants reported serious symptomatology and social disability.
Furthermore, 213 mental health professionals (mostly psychiatrists, psychotherapists, social workers, and nurses) participated. Average case load (number of patients in study per professional) was 2.76 and overall staff completion rate was 93.5%. This mean that for the vast majority study participants, data on standardised measures of CDM and outcome are available from both patient and staff perspectives. Data analysis in order to answer the main research question (relation between CDM and outcome) are ongoing.
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.
Model of clinical decision making in the care of people with severe mental illness to be tested in CEDAR
Puschner B, Steffen S, Slade M, Kaliniecka H, Maj M, Fiorillo A, Munk-Jorgensen P, Larsen JI, Egerhazi A, Nemes Z, Rössler W, Kawohl W, Becker T: Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): study protocol. BMC Psychiatry 2010, 10:90