Shared Decision-Making: Increases Autonomy in Substance-Dependent Patients

Abstract

This study examines the effect of a shared decision-making intervention (SDMI) on patients’ and clinicians’ self-perceived interpersonal behavior. Clinicians (n = 34) in three addiction treatment centers in the Netherlands were randomly assigned to SDMI or treatment decision-making as usual. Patients receiving inpatient treatment in 2005–2006 were included (n = 212). Baseline characteristics were measured by the European Addiction Severity Index (EuropASI) and the Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM). Treatment goals were assessed using the Goals of Treatment Questionnaire (GoT-Q) plus a Q-sort ranking procedure. Interpersonal behavior was measured by Interpersonal Checklist—Revised (ICL-R) at baseline, end of treatment, and 3-month follow-up. Repeated measures analyses of variance and multiple hierarchical linear regression analysis were used. The key finding of this study was that SDMI is associated with an increase of patient autonomy (independent behavior) and control behavior. The study limitations have been noted.

RÉSUMÉ

Prise de decision partagée: Augmente l'autonomie des patients dependant aux substances

Cette étude examine les effets de l'intervention basée sur la prise de décision partagée (SDMI) sur les comportements inter-personnels auto-perçus par les patients et les cliniciens. Des cliniciens (n = 34) de trois centres de traitement en Hollande ont été répartis de manière aléatoire dans le groupe SDMI ou le groupe prise de décision thérapeutique habituelle. Les patients admis pour traitement non-ambulatoire entre 2005–2006 ont été inclus (n = 212). Les caractéristiques de base ont été évaluées par le biais du European Addiction Severity Index (EuropASI) et le Composite International Diagnostic Interview –Substance abuse module (CIDI-SAM). Les objectifs thérapeutiques ont été évalués par le biais du Goals of Treatment Questionnaire (GoT-Q) et d'une procédure de classification de type Q-sort. Les comportements interpersonnels ont été mesures par la Interpersonnal Checklist-Revised (ICL-R) à l'admission dans l’étude, la fin du traitement et après trois mois de suivi. Des analyses de variances sur mesures répétées, ainsi qu'une analyse de régression linéaire multiple hiérarchique, ont été utilisées. Le résultat clé de cette étude est que la SDMI est associée avec une amélioration de l'autonomie du patient (comportement indépendant) et du comportement contrôle. Les limitations de cette étude sont également discutées.

RESUMEN

La Toma de decisiones compartida: Aumenta la autonomía de los pacientes dependientes de sustancias

Este estudio examina el efecto de una intervención de toma de decisiones compartidas (shared decision-making intervention –SDMI) en el comportamiento de auto-percepción interpersonal entre pacientes y profesionales de la salud. Los profesionales de la salud (n = 34) fueron reclutados en tres centros especialiazados en el tratamiento de adicciones en los Países Bajos, estos fueron asignados aleatoriamente a la intervención de toma de decisiones compartida (SDMI) o al tratamiento usual de toma de decisiones. Todos los pacientes (n = 212) que recibieron tratamiento hospitalario en el período 2005–2006 fueron incluidos en este estudio. Las variables fueron medidas por el Índice Europeo de Severidad de la Adicción (EuropASI) y la Entrevista Diagnóstica Internacional Compuesta –Módulo de Abuso de Sustancias (CIDI-SAM). Los objetivos del tratamiento se evaluaron utilizando el Cuestionario de Objetivos del Tratamiento (Goals of Treatment Questionnaire GoT-Q) y de un procedimiento de ranking (Q-sort ranking). La conducta interpersonal se evaluó con la Lista Interpersonal Revisada (Interpersonal Checklist Revised, ICL-R) al inicio del estudio, al final del tratamiento, y 3 meses después de la finalización del mismo. Análisis de varianza con medidas repetidas y regresión lineal múltiple (modelo jerárquico) fueron aplicados. La conclusión principal de este estudio es que la intervención toma de decisiones compartida (SDMI) se asocia con un aumento de la autonomía del paciente (comportamiento independiente) y el comportamiento de control. Las limitaciones de este estudio son tomadas en consideración en este artículo.

Keywords :

• substance-use-related disorders
• decision-making
• interpersonal relation
• patient autonomy

THE AUTHORS

Evelien A. G. Joosten, Ph.D., is Psychologist and Senior Researcher at the Vincent van Gogh Institute (Department Addiction Treatment) in the Netherlands. She studied Clinical Child Psychology and Clinical Neuropsychology at the University of Tilburg, the Netherlands. Her clinical and research interests have been substance use disorders, shared decision-making, and therapeutic relationship. She is a member of the Nijmegen Institute for Scientist Practitioners in Addiction.

Cor A. J. De Jong, M.D., Ph.D., is a Professor of Addiction Sciences at the Faculty of Social Sciences of Radboud University Nijmegen. He is the Scientific Director of the Nijmegen Institute for Scientist Practitioners in Addiction. His research interests have always been the comorbidity of substance use disorders and other psychiatric disorders, especially personality disorders in relation to the interpersonal model of personality. Recently, his research focuses on the chronicity of substance use disorders. He is the Principal Lecturer of the Dutch Master in Addiction Medicine and one of the founders of the Dutch Physicians Health Program.

Gerdien H. de Weert-van Oene, M.P.H., Ph.D., studied medicine at the University Medical Center in Utrecht, the Netherlands. Currently, she is a Senior Researcher at IrisZorg, center for addiction treatment and rehabilitation. Her research areas are dual diagnosis, demoralization, motivation for treatment, and rehabilitation. She is a member of the Nijmegen Institute for Scientist Practitioners in Addiction.

Tom Sensky, Ph.D., F.R.C.Psych., is Emeritus Professor of Psychological Medicine at the Imperial College London. He has a long-standing clinical and research interest in complex interventions and in chronic illness, both physical and mental.

Cees P. F. van der Staak, Ph.D., is Emeritus Professor of Clinical Psychology at the Faculty of Social Sciences of Radboud University Nijmegen and former Head of the Professional Training Program of Clinical Psychologists. His research interests cover the broad range of anxiety, addiction, and psychopathology.