Research Type

Consumer/Patient Level

Collaborators

• Michelle Salyers, PhD
• Adam Hirsh, PhD
• Sadaaki Fukui, PhD
• Marianne Mathias, PhD
• Kevin Rand, PhD
• Jennifer Garabrant, BSW
• Lindsey Jones, BA
• Alexis Grant, BS, MA
• Eduardo Salgado, BS
• AJ Muth, BA

Outside Collaborators

• Lisa Dixon, MD
• Ashley Overely, MD
• Shankar Manamalkav, MD
• Benjamin Lok, PhD
• Mohan Zalake, BA, MA
• Yuzho Dong, BS, MS

Background

Shared Decision Making (SDM) -- a process in which patients and treatment providers work collaboratively to make decisions -- is an ethical imperative and is critical for high-quality, recovery-oriented care. Yet, despite efforts to implement recovery-oriented care, people with severe mental illness (SMI) still have difficulty engaging as active partners in psychiatric treatment. Moreover, few SDM interventions have been developed specifically for people with SMI, and the most well-known is a highly resource-intensive program. The current study outlines a pilot effectiveness trial of a low-cost, high-innovation approach called GET PrEPD-Psychiatry (Goal Elicitation, Treatment Prioritization, & Electronically-Practiced Discussion). Originally developed to enhance SDM in chronic pain patients, GET PrEPD-Psychiatry participants will receive individual, in-person coaching to clarify/prioritize their goals, determine treatment preferences and rationale for these preferences, and develop skills to engage in SDM. Patients will also practice these skills in online interactions with computer-simulated “Virtual Providers” who interact with patients via audio and onscreen text. Interactions with Virtual Providers will be tailored to patients’ unique learning styles, thereby, enhancing skills mastery and communication self-efficacy.

Objectives

1. Adapt Virtual Providers in GET PrEPD for use in psychiatric decision-making. We are using transcripts of actual provider visits develop Virtual Provider language and responses that are grounded in actual psychiatry conversations. We will conduct an iterative series of usability trials and cognitive interviewing with approximately 10 participants to refine the Virtual Provider interactions.
2. Pilot test GET PrEPD-Psychiatry to determine feasibility and acceptability in a community mental health setting. We will recruit 40 outpatients to participate in GET PrEPD-Psychiatry (4 weekly goal-setting/coaching sessions, coupled with Virtual Provider training and practice). We will assess participant satisfaction and utility ratings, as well as track participant use of the Virtual Provider program.
3. Examine potential mechanisms of change and preliminary outcomes of GET PrEPD-Psychiatry. GET PrEPD-Psychiatry targets patient activation by helping patients to prioritize treatment goals and preferences within their broader life context. GET PrEPD-Psychiatry targets communication self-efficacy by teaching essential communication skills, such as agenda setting and question asking, and providing opportunities for individualized, repeated practice to facilitate mastery of these new skills. We will assess participants at baseline and 3 months, using self-reported instruments and audio-recorded observations of a medication visit with their provider. We hypothesize:
   1. improved mechanisms of change (i.e., increases in activation and communication self-efficacy)
   2. improved SDM based on coded audio-recorded clinic visits
   3. improved self-management and recovery attitudes

Impact

The intervention will help adults with severe mental illness to identify and prioritize their treatment goals and to communicate more effectively with their psychiatric treatment providers, which should enhance treatment engagement, activation, communication self-efficacy, and recovery outcomes.

Successful completion of this project will also result in a new, low-cost, highly scalable intervention that can be implemented across a range of psychiatric treatment settings to reach a large number of patients.