- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01031134
Shared Decision-Making for Elderly Depressed Primary Care Patients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Shared Decision Making (SDM) may be particularly relevant for depressed individuals, as it seeks to enhance their autonomy and empowerment in a manner that directly addresses the helplessness and hopelessness associated with depression. Shared decision-making interventions are being developed for depression in primary care, but have yet to be adequately tested. It is also unknown whether the same premises regarding shared decision-making's ability to enhance autonomy and empowerment pertain to elderly populations.
This randomized study will recruit elderly depressed primary care patient subjects and evaluate the impact of a three-session SDM nursing intervention on their (1) adherence to antidepressant medication or psychotherapy and on (2) their reduction in depressive symptoms. The comparison group will be physician-recommended Usual Care (UC). The focus of the SDM intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that can be successfully implemented.
The study randomizes physicians to provide their depressed patients with SDM or UC. A total of 210 elderly depressed patient subjects whose physicians recommend starting depression treatment, will receive either Shared Decision-Making (SDM) or the physician recommended Usual Care (UC) comparison condition. Participants will be assessed at baseline and at weeks 4, 8, 12, and 24 to determine treatment adherence and depressive status. Nurses currently employed by the participating physicians will administer the SDM intervention.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
-
Bronx, New York, United States, 10451
- Lincoln Hospital - the New York City Health and Hospitals Corporation (HHC)
-
White Plains, New York, United States, 10605
- Cornell Institute of Geriatric Psychiatry
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age: 65 years and older;
- Medical outpatient presenting to Lincoln Hospital, Bronx NY, the New York City Health and Hospitals Corporation (HHC);
- Screen positive (PHQ-9 score>9 for depression, in addition to primary care physician recommendation for depression treatment.
Exclusion Criteria:
- Presence of significant alcohol or substance abuse, psychotic disorder, or bipolar disorder;
- High suicide risk, i.e. intent or plan to attempt suicide in near future;
- Current treatment with antidepressant medication or psychotherapy prior to index physician visit (with the exception of low doses of antidepressant medication for pain disorders);
- Cognitive impairment: MMSE score <20 or clinical diagnosis of dementia;
- Acute or severe medical illness, i.e., delirium, metastatic cancer, decompensated cardiac, liver, or kidney failure, major surgery, stroke or myocardial infarction during the three months prior to entry; or drugs often causing depression, e.g., steroids, reserpine, alpha-methyl-dopa, tamoxifen, vincristine;
- Aphasia interfering with communication.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Shared Decision Making
1 in person session followed by 2 telephone calls 1 and 2 weeks later.
|
Shared decision-making, in contrast to traditional medical decision-making, involves a collaborative process where patients discuss personal values and preferences and clinicians provide information to arrive at an agreed upon treatment decision.
The focus of the intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that can be successfully implemented.
|
Active Comparator: Usual Care
Physician Usual Care of depressed patients.
|
Usual Care reflects the standard of care in primary care practice: following physician recommendation for treatment.
Physicians will recommend some form of depression treatment.
This may take the form of an antidepressant prescription or psychotherapy referral.
The physician will encourage patients to telephone with any questions.
Following the treatment recommendation provided to the patient, the physician will provide care as usual.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants Who Adhered to Physician Recommended Treatment
Time Frame: 12 weeks
|
Any mental health service use over 12 weeks.
|
12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Hamilton Depression Rating Scale Scores
Time Frame: Baseline and 12 week
|
Hamilton Depression Rating Scale change score from baseline to 12 weeks.
This scale measures severity of depressive symptoms (range 0-76), with higher scores indicating more severe symptomatology.
|
Baseline and 12 week
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Patrick J. Raue, Ph.D., Weill Medical College of Cornell University
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1R01MH084872-01A1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Depression
-
ProgenaBiomeRecruitingDepression | Depression, Postpartum | Depression, Anxiety | Depression Moderate | Depression Severe | Clinical Depression | Depression in Remission | Depression, Endogenous | Depression ChronicUnited States
-
Washington University School of MedicineCompletedTreatment Resistant Depression | Late Life Depression | Geriatric Depression | Refractory Depression | Therapy-Resistant DepressionUnited States, Canada
-
Kintsugi Mindful Wellness, Inc.Sonar Strategies; Vituity PsychiatryRecruitingDepression | Depression Moderate | Depression Severe | Depression MildUnited States
-
University of California, San FranciscoRecruitingDepression Moderate | Depression Mild | Depression, TeenUnited States
-
University GhentUniversiteit Antwerpen; Janssen-Cilag Ltd.RecruitingDepression Moderate | Depression Severe | Depression MildBelgium
-
Baylor College of MedicineUniversity of TexasRecruitingDepression | Depression Moderate | Depression Severe | Suicide and Self-harm | Depression in Adolescence | Depression MildUnited States
-
University of Cape TownNational Institute of Mental Health (NIMH)CompletedPostpartum Depression | Clinical Depression | Moderate DepressionSouth Africa
-
Northern Illinois UniversityUniversity Autonoma de Santo DomingoTerminatedDepression Moderate | Depression MildUnited States, Dominican Republic
-
Washington University School of MedicinePatient-Centered Outcomes Research Institute; National Institute of Mental...CompletedMajor Depressive Disorder | Treatment Resistant Depression | Treatment-Refractory Depression | Late Life Depression | Geriatric DepressionUnited States, Canada
-
Lawson Health Research InstituteTerminated
Clinical Trials on Shared Decision Making
-
The University of Texas Health Science Center,...TerminatedPregnancy Related | Elective InductionUnited States
-
Shalvata Mental Health CenterUnknownShared Decision Making With PatientsIsrael
-
Umeå UniversityUnknownPsychosis | Participation, Patient | Psychiatric HospitalizationSweden
-
AstraZenecaBrigham Women's HealthCompletedDiabetes Mellitus Type 2United States
-
National Heart, Lung, and Blood Institute (NHLBI)CompletedLung Diseases | Asthma
-
Yokohama City UniversityCompleted
-
Christiana Care Health ServicesNational Institute of General Medical Sciences (NIGMS); Thomas Jefferson University and other collaboratorsCompleted
-
UMC UtrechtCompletedShared Decision Making Between Patients and GPs in the Treatment of Type 2 Diabetes in Primary Care.Type 2 Diabetes MellitusNetherlands
-
National Heart, Lung, and Blood Institute (NHLBI)Completed
-
SingHealth PolyclinicsSingapore General HospitalCompletedPatient Engagement | Patient PreferenceSingapore