The effects of treatment as usual versus a computerized clinical decision aid on shared decision-making in the treatment of psychotic disorders

Background and objectives: People with psychotic disorders can experience a lack of active involvement in their decisional process. Clinical decision aids are shared decision-making tools which are currently rarely used in mental healthcare. We examined the effects of Treatment E-Assist (TREAT), a computerized clinical decision aid in psychosis care, on shared decision-making and satisfaction with consultations as assessed by patients. Methods: A total of 187 patients with a psychotic disorder participated. They received either treatment as usual in the first phase (TAU1), TREAT in the second phase or treatment as usual in the third phase of the trial (TAU2). The Decisional Conflict Scale was used as primary outcome measure for shared decision-making and patient satisfaction as secondary outcome. Results: A linear mixed model analysis found no significant effects between TAU 1 (ß = -0.54, SE = 2.01, p = 0.80) and TAU 2 (ß = -1.66, SE = 2.63, p = 0.53) compared to TREAT on shared decision-making. High patient rated satisfaction with the consultations was found with no significant differences between TAU 1 (ß = 1.48, SE = 1.14, p = 0.20) and TAU 2 (ß = 2.26, SE = 1.33, p = 0.09) compared to TREAT. Conclusion: We expected TREAT to enhance shared decision-making without decreasing satisfaction with consultations. However, no significant differences on shared decision-making or satisfaction with consultations were found. Our findings suggest that TREAT is safe to implement in psychosis care, but more research is needed to fully understand its effects on the decisional process.