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Survey shows mismatched priorities, low shared decision-making in depression care

A national survey of consumers and clinicians making depression treatment decisions indicated that although clinicians are aware of consumer priorities, they do not always address them.

“Shared decision-making (SDM) aims to generate greater alignment between patient preferences and chosen treatments with a view to improving subsequent treatment outcomes. When individuals with depression are involved in SDM, treatment selection, adherence, satisfaction and outcomes are improved. Yet many individuals with depression experience inadequate SDM,” Paul J. Barr, MSc, PhD, of the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and colleagues wrote.

To determine information priorities for consumers and clinicians making depression treatment decisions and to assess SDM in routine depression care, researchers conducted online cross-sectional surveys from September to December 2014 among 972 consumers and 244 clinicians.

The highest ranked question for consumers and clinicians was ‘Will the treatment work?’

Overall, 18% of consumers reported high levels of SDM.

According to researchers, clinicians were aware of consumer priorities but did not always prioritize that information themselves, particularly insurance coverage and cost of treatment.

Working with a psychiatrist (OR = 1.87; 95% CI, 1.07-3.26) and female gender (OR = 2.04; 95% CI, 1.25-3.34) were associated with high scores on CollaboRATE, a measure of SDM.

“While clinicians are aware of what matters most to consumers with depression, they do not always prioritize this information. Low SDM combined with a misalignment in information priorities between consumers and clinicians may explain why consumers often do not receive their preferred treatments,” Barr and colleagues wrote. “Better equipping clinicians to talk to consumers about information central to consumer decision-making, such as the cost and insurance coverage associated with different treatment options, can lead to more engaged and empowered consumers. This is of particular interest given the expansion of mental health coverage and depression screening resulting from the Patient Protection and Affordable Care Act.” – by Amanda Oldt

Disclosure: Barr reports intellectual conflict of interest for holding copyright of CollaboRATE. Please see the full study for a list of all authors’ relevant financial disclosures.