Development of a Decision Aid in Support of Shared Decision-Making for Treatment-Resistant Depression

Shared decision-making (SDM) involves patients and clinicians choosing treatment together. SDM in mental health is hampered by lack of well-developed supporting tools. We describe an evidence-based decision aid (DA) to facilitate SDM for treatment-resistant depression (TRD) consistent with National Quality Forum (NQF) standards.

Methods: A DA was developed by a multidisciplinary steering committee of clinicians, patient advocates, patients and decision scientists. The development process included defining scope and domains important in TRD decision-making, creating content and designing a structure for clinical practice integration. Development was guided by systematic literature review and clinician/patient input. Ten patients assessed the DA during focus groups.

Results: A web-based DA was designed to present options when >2 optimized medication regimens and talk therapy achieves inadequate patient symptom control. Options include electroconvulsive therapy, esketamine nasal spray, transcranial magnetic stimulation and continuing oral therapy. We identified six preference-sensitive domains important for choosing among treatments 1) effectiveness, 2) administration method, 3) side-effects, 4) impact on working/driving, 5) time to therapeutic onset and need for maintenance, 6) cost. The DA presents risk-benefit information for patients invited to interact with the aid by their clinician and includes exercises to elicit values, goals and treatment preferences. Focus-groups rated the DA high on its ability to clearly present risk-benefit information in an unbiased way, clarify what is important to patients, and prepare them for SDM with a clinician.

Conclusions: A TRD DA was developed to help treatment shared decision-making. A future study to determine impact on decision-making quality is in development.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.