Continue, adjust, or stop antipsychotic medication: developing and user testing an encounter decision aid for people with first-episode and long-term psychosis

Yaara Zisman-Ilani, David Shern, Patricia Deegan, Julie Kreyenbuhl, Lisa Dixon, Robert Drake, William Torrey, Manish Mishra, Ksenia Gorbenko, Glyn Elwyn, Yaara Zisman-Ilani, David Shern, Patricia Deegan, Julie Kreyenbuhl, Lisa Dixon, Robert Drake, William Torrey, Manish Mishra, Ksenia Gorbenko, Glyn Elwyn

Abstract

Background: People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics.

Methods: A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation.

Results: An EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents.

Conclusions: The EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.

Keywords: Antipsychotic medication; Decision aid; Decision support tool; Option grid; Psychosis; Shared decision making.

Conflict of interest statement

Ethics approval and consent to participate

The Committee for the Protection of Human Subjects at Dartmouth College approved the study (CPHS. no. STUDY00029267). The study was approved with no greater than minimal risk to participants and signed consent was waived per 45 CFR 46.117(c). We obtained verbal consent from all respondents at the time of the interview and written consent for face-to-face interviews. Participants received information about the project in a letter read before the interview. It was emphasized that participation was voluntary. Participants were informed that the information they gave in the interviews would be published in anonymized form.

Competing interests

YZI, DS, PD, JK, LD, RD, WT, MM, and KG declare that they have no competing interests.

GE has no financial conflicts of interest. GE is involved in the development of Option Grid™ decision aids.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Number of quotations† regarding the appearance and content of the EDA

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