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.

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. TRIAL REGISTRATION: ClinicalTrials.gov NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi: 10.1186/s12888-019-2143-2.

Momentum: A smartphone application to support shared decision making for people using mental health services.

OBJECTIVE: The aim of the pilot study was to examine the use of a smartphone application as a modern decision aid to support shared decision making in mental health. METHOD: 78 people using mental health services and 116 of their providers participated in a 4-month pilot study. At the end of the intervention, we conducted 3 focus group interviews with 12 multidisciplinary staff members, 1 focus group interview with doctors, and 7 individual interviews with consumers. Each interview was recorded and systematically reviewed to identify common themes and both similar and different traits between respondents through a process of induction. RESULTS: Consumers and providers found the application a useful tool to support people in recovery in providing an overview and setting an agenda. However, the pilot study found more technological obstacles to its use. Some results indicate an obstacle perhaps relating to the power asymmetry between people using mental health services and staff. Contrary to our hypothesis that peer support would be crucial, the use of the application was most widespread when it was presented to consumers by providers who found it was a useful tool. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results indicate the relevance of using modern technology to support shared decision making (SDM) and the recovery model, though raise the question of how the actual use in the study is to be understood. The study thereby points to a need of further research into the understanding of the central consumer-provider relationship in SDM and in how decision aids are presented. (PsycINFO Database Record