Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)
Aims. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
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Cambridge University Press
2016
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| Online Access: | https://eprints.nottingham.ac.uk/31585/ |
| _version_ | 1848794231959715840 |
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| author | Puschner, B. Becker, T. Mayer, B. Jordan, H. Maj, M. Fiorillo, A. Égerházi, A. Ivánka, T. Munk-Jørgensen, P. Krogsgaard Bording, M. Rössler, W. Kawohl, W. Slade, Mike |
| author_facet | Puschner, B. Becker, T. Mayer, B. Jordan, H. Maj, M. Fiorillo, A. Égerházi, A. Ivánka, T. Munk-Jørgensen, P. Krogsgaard Bording, M. Rössler, W. Kawohl, W. Slade, Mike |
| author_sort | Puschner, B. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Aims. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.
Methods. CEDAR (ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. 588 adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Germany, UK, Italy, Hungary, Denmark, and Switzerland). Clinical decision making was measured using two instruments (Clinical Decision Making Style Scale.
CDMS;Clinical Decision Making Involvement and Satisfaction Scale, CDIS) from patient and staff perspectives. Outcomes assessed were unmet needs (Camberwell Assessment of Need Short Appraisal Schedule, CANSAS). Mixed-effects multinomial regression was used to examine differences in involvement in and satisfaction with actual decision making. The effect of clinical decision making on outcome was examined using hierarchical linear modelling controlling for covariates.
Results. Shared decision making was preferred by patients (2=135.08; p<0.001) and staff (2=368.17; p<0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (-0.406 unmet needs per two months, p=0.007) or shared (-0.303 unmet needs per two months, p=0.015) decision making.
Conclusions. A shift from shared to active involvement of patients is indicated, including the development and rigorous test of targeted interventions. |
| first_indexed | 2025-11-14T19:12:55Z |
| format | Article |
| id | nottingham-31585 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:12:55Z |
| publishDate | 2016 |
| publisher | Cambridge University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-315852024-08-15T15:32:20Z https://eprints.nottingham.ac.uk/31585/ Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) Puschner, B. Becker, T. Mayer, B. Jordan, H. Maj, M. Fiorillo, A. Égerházi, A. Ivánka, T. Munk-Jørgensen, P. Krogsgaard Bording, M. Rössler, W. Kawohl, W. Slade, Mike Aims. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome. Methods. CEDAR (ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. 588 adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Germany, UK, Italy, Hungary, Denmark, and Switzerland). Clinical decision making was measured using two instruments (Clinical Decision Making Style Scale. CDMS;Clinical Decision Making Involvement and Satisfaction Scale, CDIS) from patient and staff perspectives. Outcomes assessed were unmet needs (Camberwell Assessment of Need Short Appraisal Schedule, CANSAS). Mixed-effects multinomial regression was used to examine differences in involvement in and satisfaction with actual decision making. The effect of clinical decision making on outcome was examined using hierarchical linear modelling controlling for covariates. Results. Shared decision making was preferred by patients (2=135.08; p<0.001) and staff (2=368.17; p<0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (-0.406 unmet needs per two months, p=0.007) or shared (-0.303 unmet needs per two months, p=0.015) decision making. Conclusions. A shift from shared to active involvement of patients is indicated, including the development and rigorous test of targeted interventions. Cambridge University Press 2016-02 Article PeerReviewed Puschner, B., Becker, T., Mayer, B., Jordan, H., Maj, M., Fiorillo, A., Égerházi, A., Ivánka, T., Munk-Jørgensen, P., Krogsgaard Bording, M., Rössler, W., Kawohl, W. and Slade, Mike (2016) Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR). Epidemiology and Psychiatric Sciences, 25 (01). pp. 69-79. ISSN 2045-7979 Community mental health; health service research; clinical decision making; prospective study; quality of care http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10111912&fileId=S204579601400078X doi:10.1017/S204579601400078X doi:10.1017/S204579601400078X |
| spellingShingle | Community mental health; health service research; clinical decision making; prospective study; quality of care Puschner, B. Becker, T. Mayer, B. Jordan, H. Maj, M. Fiorillo, A. Égerházi, A. Ivánka, T. Munk-Jørgensen, P. Krogsgaard Bording, M. Rössler, W. Kawohl, W. Slade, Mike Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) |
| title | Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) |
| title_full | Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) |
| title_fullStr | Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) |
| title_full_unstemmed | Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) |
| title_short | Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR) |
| title_sort | clinical decision making and outcome in the routine care of people with severe mental illness across europe (cedar) |
| topic | Community mental health; health service research; clinical decision making; prospective study; quality of care |
| url | https://eprints.nottingham.ac.uk/31585/ https://eprints.nottingham.ac.uk/31585/ https://eprints.nottingham.ac.uk/31585/ |