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Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study

BACKGROUND: Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery. METHODS: Data derived from an observational cohort study “Cl...

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Autores principales: Loos, Sabine, Clarke, Eleanor, Jordan, Harriet, Puschner, Bernd, Fiorillo, Andrea, Luciano, Mario, Ivánka, Tibor, Magyar, Erzsébet, Krogsgaard-Bording, Malene, Østermark-Sørensen, Helle, Rössler, Wulf, Kawohl, Wolfram, Mayer, Benjamin, Slade, Mike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260092/
https://www.ncbi.nlm.nih.gov/pubmed/28114913
http://dx.doi.org/10.1186/s12888-017-1207-4
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author Loos, Sabine
Clarke, Eleanor
Jordan, Harriet
Puschner, Bernd
Fiorillo, Andrea
Luciano, Mario
Ivánka, Tibor
Magyar, Erzsébet
Krogsgaard-Bording, Malene
Østermark-Sørensen, Helle
Rössler, Wulf
Kawohl, Wolfram
Mayer, Benjamin
Slade, Mike
author_facet Loos, Sabine
Clarke, Eleanor
Jordan, Harriet
Puschner, Bernd
Fiorillo, Andrea
Luciano, Mario
Ivánka, Tibor
Magyar, Erzsébet
Krogsgaard-Bording, Malene
Østermark-Sørensen, Helle
Rössler, Wulf
Kawohl, Wolfram
Mayer, Benjamin
Slade, Mike
author_sort Loos, Sabine
collection PubMed
description BACKGROUND: Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery. METHODS: Data derived from an observational cohort study “Clinical decision making and outcome in routine care for people with severe mental illness” (CEDAR). Adults (aged 18–60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change. RESULTS: Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15–2.94) or passive (OR = 1.71, 95% CI = 1.00–2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery. CONCLUSIONS: Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
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spelling pubmed-52600922017-01-26 Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study Loos, Sabine Clarke, Eleanor Jordan, Harriet Puschner, Bernd Fiorillo, Andrea Luciano, Mario Ivánka, Tibor Magyar, Erzsébet Krogsgaard-Bording, Malene Østermark-Sørensen, Helle Rössler, Wulf Kawohl, Wolfram Mayer, Benjamin Slade, Mike BMC Psychiatry Research Article BACKGROUND: Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery. METHODS: Data derived from an observational cohort study “Clinical decision making and outcome in routine care for people with severe mental illness” (CEDAR). Adults (aged 18–60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change. RESULTS: Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15–2.94) or passive (OR = 1.71, 95% CI = 1.00–2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery. CONCLUSIONS: Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010). BioMed Central 2017-01-23 /pmc/articles/PMC5260092/ /pubmed/28114913 http://dx.doi.org/10.1186/s12888-017-1207-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Loos, Sabine
Clarke, Eleanor
Jordan, Harriet
Puschner, Bernd
Fiorillo, Andrea
Luciano, Mario
Ivánka, Tibor
Magyar, Erzsébet
Krogsgaard-Bording, Malene
Østermark-Sørensen, Helle
Rössler, Wulf
Kawohl, Wolfram
Mayer, Benjamin
Slade, Mike
Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
title Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
title_full Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
title_fullStr Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
title_full_unstemmed Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
title_short Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
title_sort recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260092/
https://www.ncbi.nlm.nih.gov/pubmed/28114913
http://dx.doi.org/10.1186/s12888-017-1207-4
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