We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Effectiveness of the DECIDE Interventions on Shared Decision Making and Perceived Quality of Care in Behavioral Health With Multicultural Patients: A Randomized Clinical Trial.
- Authors
Alegria, Margarita; Nakash, Ora; Johnson, Kirsten; Ault-Brutus, Andrea; Carson, Nicholas; Fillbrunn, Mirko; Wang, Ye; Cheng, Alice; Harris, Treniece; Polo, Antonio; Lincoln, Alisa; Freeman, Elmer; Bostdorf, Benjamin; Rosenbaum, Marcos; Epelbaum, Claudia; LaRoche, Martin; Okpokwasili-Johnson, Ebele; Carrasco, MaJose; Shrout, Patrick E.
- Abstract
<bold>Importance: </bold>Few randomized clinical trials have been conducted with ethnic/racial minorities to improve shared decision making (SDM) and quality of care.<bold>Objective: </bold>To test the effectiveness of patient and clinician interventions to improve SDM and quality of care among an ethnically/racially diverse sample.<bold>Design, Setting, and Participants: </bold>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.<bold>Interventions: </bold>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.<bold>Main Outcomes and Measures: </bold>The SDM was assessed by a blinded coder based on clinical recordings, patient perception of SDM and quality of care, and clinician perception of SDM.<bold>Results: </bold>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.<bold>Conclusions and Relevance: </bold>The clinician intervention could improve SDM with minority populations, and the patient intervention could augment patient-reported quality of care.<bold>Trial Registration: </bold>clinicaltrials.gov Identifier: NCT01947283.
- Subjects
MENTAL health services; MULTICULTURALISM; MEDICAL quality control; RACIAL minorities; MEDICAL decision making; TREATMENT effectiveness; HEALTH
- Publication
JAMA Psychiatry, 2018, Vol 75, Issue 4, p325
- ISSN
2168-622X
- Publication type
journal article
- DOI
10.1001/jamapsychiatry.2017.4585