Impact of clinical decision-making participation and satisfaction on outcomes in mental health practice: results from the CEDAR European longitudinal study

Abstract

The present study aimed to assess: (1) whether a more active involvement of patients is associated with an improvement of clinical symptoms, global functioning, and quality-of-life; and (2) how patients’ satisfaction with clinical decisions can lead to better outcome after 1 year. Data were collected as part of the study ‘Clinical decision-making and outcome in routine care for people with severe mental illness (CEDAR)’, a longitudinal observational study, funded by the European Commission and carried out in six European countries. Patients’ inclusion criteria were: (a) aged between 18 and 60 years; (b) diagnosis of a severe mental illness of any kind according to the Threshold Assessment Grid (TAG) ≥ 5 and duration of illness ≥ 2 years; (c) expected contact with the local mental health service during the 12-month observation period; (d) adequate skills in the language of the host countries; and (e) the ability to provide written informed consent. The clinical decision-making styles of clinicians and the patient satisfaction with decisions were assessed using the Clinical Decision Making Style and the Clinical Decision Making Involvement and Satisfaction scales, respectively. Patients were assessed at baseline and 1 year after the recruitment. The sample consisted of 588 patients with severe mental illness, mainly female, with a mean age of 41.69 (±10.74) and a mean duration of illness of 12.5 (±9.27) years. The majority of patients were diagnosed with psychotic (45.75%) or affective disorders (34.01%). At baseline, a shared CDM style was preferred by 70.6% of clinicians and about 40% of patients indicated a high level of satisfaction with the decision and 31% a medium level of satisfaction. Higher participation in clinical decisions was associated with improved social functioning and quality-of-life, and reduced interpersonal conflicts, sense of loneliness, feelings of inadequacy, and withdrawal in friendships after 1 year (p < 0.05). Moreover, a higher satisfaction with decisions was associated with a better quality-of-life (p < 0.0001), reduced symptom severity (p < 0.0001), and a significantly lower illness burden associated with symptoms of distress (p < 0.0001), interpersonal difficulties (p < 0.0001), and problems in social roles (p < 0.05). Our findings clearly show that a higher involvement in and satisfaction of patients with clinical decision-making was associated with better outcomes. More efforts have to be made to increase the involvement of patients in clinical decision-making in routine care settings.

Keywords:

• Clinical decision-making
• outcome
• severe mental disorders
• quality-of-life
• outcome questionnaire
• global functioning

Acknowledgements

CEDAR is a multicenter collaboration between the Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Germany (Bernd Puschner); the Section for Recovery, Institute of Psychiatry, London, U.K. (Mike Slade); the Department of Psychiatry, University of Campania ‘L. Vanvitelli’ (Mario Maj); the Department of Psychiatry, Debrecen University, Hungary (Anikó Égerházi); the Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Denmark (Povl Munk-Jørgensen); and the Department of General and Social Psychiatry, University of Zurich, Switzerland (Wulf Rössler).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by a grant from the European Union’s Seventh Framework Programme [Grant agreement number: 223290].