TY - JOUR

T1 - A Smartphone App to Promote Patient Activation and Support Shared Decision-making in People With a Diagnosis of Schizophrenia in Outpatient Treatment Settings (Momentum Trial)

T2 - Randomized Controlled Assessor-Blinded Trial

AU - Vitger, Tobias

AU - Hjorthøj, Carsten

AU - Austin, Stephen F.

AU - Petersen, Lone

AU - Tønder, Esben Sandvik

AU - Nordentoft, Merete

AU - Korsbek, Lisa

N1 - Publisher Copyright: ©Tobias Vitger, Carsten Hjorthøj, Stephen F Austin, Lone Petersen, Esben Sandvik Tønder, Merete Nordentoft, Lisa Korsbek. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.10.2022.

PY - 2022

Y1 - 2022

N2 - BACKGROUND: Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of accessibility, structure, and reminders. OBJECTIVE: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to support patient activation and SDM. METHODS: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia, schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance, satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the intervention at the midintervention time point along with objective data on the use of the digital tool were collected. RESULTS: In total, 194 participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one's provider (mean difference 1.85, 95% CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use of antipsychotic medicine, and number or length of psychiatric hospital admissions. CONCLUSIONS: This trial showed a significant effect of a digital SDM tool on the subjective level of patient activation, confidence in communicating with one's provider, and feeling prepared for decision-making at the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes to the evidence on how digital tools may support patient-centered care and SDM in mental health care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi: 10.1186/s12888-019-2143-2.

AB - BACKGROUND: Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of accessibility, structure, and reminders. OBJECTIVE: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to support patient activation and SDM. METHODS: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia, schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance, satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the intervention at the midintervention time point along with objective data on the use of the digital tool were collected. RESULTS: In total, 194 participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one's provider (mean difference 1.85, 95% CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use of antipsychotic medicine, and number or length of psychiatric hospital admissions. CONCLUSIONS: This trial showed a significant effect of a digital SDM tool on the subjective level of patient activation, confidence in communicating with one's provider, and feeling prepared for decision-making at the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes to the evidence on how digital tools may support patient-centered care and SDM in mental health care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi: 10.1186/s12888-019-2143-2.

KW - digital intervention

KW - early intervention

KW - mHealth

KW - mobile health

KW - mobile phone

KW - patient activation

KW - randomized clinical trial

KW - schizophrenia

KW - schizotypal

KW - shared decision-making

U2 - 10.2196/40292

DO - 10.2196/40292

M3 - Journal article

C2 - 36287604

AN - SCOPUS:85140856034

VL - 24

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1439-4456

IS - 10

M1 - e40292

ER -