Understanding and meeting information needs for patients with posttraumatic stress disorder

Bradley V Watts, Maha H Zayed, Hilary Llewellyn-Thomas, Paula P Schnurr, Bradley V Watts, Maha H Zayed, Hilary Llewellyn-Thomas, Paula P Schnurr

Abstract

Background: Posttraumatic Stress Disorder (PTSD) is a commonly occurring mental illness. There are multiple treatments for PTSD that have similar effectiveness, but these treatments differ substantially in other ways. It is desirable to have well-informed patients involved in treatment choices. A patient decision aid (PtDA) is one method to achieve this goal. This manuscript describes the rationale and development of a patient decision aid (PtDA) designed for patients with PTSD.

Methods: We conducted an informational needs assessment of veterans (n = 19) to obtain their baseline information needs prior to the development of the PtDA. We also conducted a literature review of effective PTSD treatments, and we calculated respective effective sizes. A PtDA prototype was developed according to the guidelines from the International Patient Decision Aid Standards. These standards guided our development of both content and format for the PtDA. In accordance with the standards, we gathered feedback from patients (n = 20) and providers (n = 7) to further refine the PtDA. The information obtained from patients and the literature review was used to develop a decision aid for patients with PTSD.

Results: Patients with PTSD reported a strong preference to receive information about treatment options. They expressed interest in also learning about PTSD symptoms. The patients preferred information presented in a booklet format. From our literature review several treatments emerged as effective for PTSD: Cognitive Therapy, Exposure Therapy, Eye Movement Desensitization Therapy, Selective Serotonin Reuptake Inhibitors, venlafaxine, and risperidone.

Conclusion: It appears that the criteria set forth to develop decision aids can effectively be applied to PTSD. The resultant PTSD patient decision aid is a booklet that describes the causes, symptoms, and treatments for PTSD. Future work will examine the effects of use of the PTSD decision aid in clinical practice.

Trial registration: Clinicaltrials.gov identifier NCT00908440. Registered May 20, 2009.

Figures

Fig. 1
Fig. 1
Visual depiction of treatment efficacy

References

    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Washington, D.C: American Psychiatric Association; 2013.
    1. Schnurr PP, Lunney CA, Bovin MJ, Marx BP. Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan. Clin Psychol Rev. 2009;29:727–35. doi: 10.1016/j.cpr.2009.08.006.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Kulka RA, Shlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, et al. Trauma and the Vietnam war generation: report of the findings from the National Vietnam Veterans’ Readjustment Study. New York: Brunner/Mazel; 1990.
    1. Vaughn CA, Schell TL, Tomielian T. Prevalence of mental health problems among Iraq and Afghanistan veterans who have not received VA services. Psychiatr Serv. 2014;65:833–5. doi: 10.1176/appi.ps.201300111.
    1. Australian Centre for Posttraumatic Mental Health . Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress disorder. Melbourne: ACPMH; 2007.
    1. Foa EB, Keane TM, Friedman MJ, Cohen JA. Effective treatments for PTSD. 2. New York: Guilford; 2008.
    1. VA/DoD Clinical Practice Guideline Working Group . Management of post-traumatic stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs; Department of Defense; Office of Quality and Performance; 2010.
    1. American Psychiatric Association . Practice guidelines for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Arlington: American Psychiatric Association; 2004.
    1. National Collaborating Centre for Mental Health . Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. London: Gaskell and the British Psychological Society; 2005.
    1. Institute of Medicine . Treatment of posttraumatic stress disorder: an assessment of the evidence. Washington, DC: National Academies Press; 2008.
    1. Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault survivors. J Consult Clin Psychol. 1992;60:748–56. doi: 10.1037/0022-006X.60.5.748.
    1. Foa EB, Rothbaum BO, Riggs DS, Murdock TB. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59:715–23. doi: 10.1037/0022-006X.59.5.715.
    1. Shapiro F. Eye movement desensitization and reprocessing: basic principles, protocols and procedures. New York: Guilford Press; 2001.
    1. Brady K, Pearlstein T, Asnis GM, Baker D, Rothbaum B, Sikes CR, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000;283:1837–44. doi: 10.1001/jama.283.14.1837.
    1. Davidson JR, Rothbaum BO, van der Kolk BA, Sikes CR, Farfel GM. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry. 2001;58:485–92. doi: 10.1001/archpsyc.58.5.485.
    1. Marshall RD, Beebe KL, Oldham M, Zaninelli R. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry. 2001;158:1982–8. doi: 10.1176/appi.ajp.158.12.1982.
    1. Tucker P, Zaninelli R, Yehuda R, Ruggiero L, Dillingham K, Pitts CD. Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry. 2001;62:860–8. doi: 10.4088/JCP.v62n1105.
    1. Davidson J, Baldwin D, Stein DJ, Kuper E, Benattia I, Ahmed S, et al. Treatment of posttraumatic stress disorder with venlafaxine extended release: a six month randomized, controlled trial. Arch Gen Psychiatry. 2006;63:1158–65. doi: 10.1001/archpsyc.63.10.1158.
    1. Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psych. 2013;74:541–50. doi: 10.4088/JCP.12r08225.
    1. Institute of Medicine . Crossing the quality chasm. Washington, DC: National Academy Press; 2001.
    1. The President’s New Freedom Commission on Mental Health . Achieving the promise: transforming mental health care in America. Washington, DC: Substance Abuse and Mental Health Service Administration; 2003.
    1. Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;1
    1. Hamann J, Langer B, Winkler V, Busch R, Cohen R, Leucht S, et al. Shared decision making for in-patients with schizophrenia. Acta Psychiatr Scand. 2006;114:265–73. doi: 10.1111/j.1600-0447.2006.00798.x.
    1. Loh A, Simon D, Wills CE, Kriston L, Niebling W, Harter M. The effects of a shared decision making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns. 2007;67:324–32. doi: 10.1016/j.pec.2007.03.023.
    1. Benish SG, Imel ZE, Wampold BE. The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct comparisons. Clin Psychol Rev. 2008;28:746–58. doi: 10.1016/j.cpr.2007.10.005.
    1. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162:214–27. doi: 10.1176/appi.ajp.162.2.214.
    1. Watts BV, Schnurr PP, Zayed M, Young-Xu Y, Stender P, Llewellyn-Thomas H. A randomized controlled clinical trail of a patient decision aid for PTSD. Psych Serv. 2015;66(2):149–54. doi: 10.1176/appi.ps.201400062.
    1. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–82. doi: 10.1177/1525822X05279903.
    1. National Center for Posttraumatic Stress Disorder [homepage on the internet]. Available at ; accessed January 15, 2015.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 3. Washington, D.C: American Psychiatric Association; 1980.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 3rd ed. revised. Washington, D.C: American Psychiatric Association; 1987.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 4th ed. revised. Washington, D.C: American Psychiatric Association; 1994.
    1. Cohen J. Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Erlbaum Associates; 1988.
    1. Bryant RA, Moulds ML, Guthrie RM, Dang ST, Nixon RD. Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. J Consult Clin Psychol. 2003;71:706–12. doi: 10.1037/0022-006X.71.4.706.
    1. Lee C, Gavriel H, Drummond P, Richards J, Greenwald R. Treatment of PTSD: stress inoculation training with prolonged exposure compared to EMDR. J Clin Psychol. 2002;58:1071–89. doi: 10.1002/jclp.10039.
    1. Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297:820–30. doi: 10.1001/jama.297.8.820.
    1. Hamann J, Cohen R, Leucht S, Busch R, Kissling W. Do patients with schizophrenia wish to be involved in decisions about their medical treatment? Am J Psychiatr. 2005;162:2382–4. doi: 10.1176/appi.ajp.162.12.2382.

Source: PubMed

3
Abonnere