Depressed People May Not Be Getting the Information They Are Looking For

More than 15 million American adults seek treatment for depression each year. However, a first-of-its-kind study by researchers at The Dartmouth Institute for Health Policy & Clinical Practice reveals an eye-opening disconnect between the priorities of patients and clinicians when it comes to the information needed to make decisions about treatment options.

“The good news is that both patients and clinicians who treat depression consider whether a treatment will work to be the most important priority,” said Paul Barr, an assistant professor at The Dartmouth Institute and the study’s lead author. “However, while consumers place a high priority on cost and insurance information, clinicians do not always prioritize this as highly.”

The study, published online by BMJ Open, surveyed close to 1,000 Americans who were currently undergoing or have previously sought treatment for depression and 250 clinicians who had recently treated patients for depression in the United States. Patients were recruited to reflect the age, gender and education level of the population of U.S. adults suffering from depression. Clinicians surveyed had an average of 15 years of professional experience and included therapists, psychiatrists and primary care physicians.

In addition to whether a treatment would work, patients wanted to know about potential side effects, whether a treatment was covered by insurance, how long before it took effect and how much it would cost. Clinicians were asked to rank their information priorities about a potential treatment from their professional perspective as a clinician as well as to identify what they believed their patients would consider most important when making a treatment decision.

“What we found is although many health care providers realize that their patients want to know how much a particular treatment costs and if insurance will cover it, they don’t seem to cover these topics with their patients,” Barr says, adding that lack of communication on these topics could be attributed to time limitations during a clinical visit, the difficulties of identifying patient-specific costs and a belief that medical decisions should be based exclusively on needs, not costs.

Barr also noted that “the cost of treatment has a significant impact on a patient’s financial stability, which can impact their well-being and whether they actually begin a treatment, especially if they cannot afford it.”

In the second part of their study, Barr and his co-authors, Rachel Forcino, Manish Mishra, Rachel Blitzer and Glyn Elwyn, also asked patient-respondents the three-question CollaboRATE survey about their most recent clinic visit where depression was discussed, including how much effort they felt was made to help them understand their health issues and how well they felt the clinician listened to what was important to them regarding their health issues and next steps. Only 18% of respondents reported a high level of perceived shared decision making with their clinician, while the majority perceived a lower level of shared decision making.

Image shows a drawing of two heads.
The study’s authors note that better equipping clinicians to talk to consumers about the cost and insurance coverage associated with different treatment options could lead to more “engaged and empowered consumers,” which they state is of particular interest given the expansion of mental health coverage and depression screening under the Affordable Care Act. Credit: Joan M. Mas.

The study’s authors note that better equipping clinicians to talk to consumers about the cost and insurance coverage associated with different treatment options could lead to more “engaged and empowered consumers,” which they state is of particular interest given the expansion of mental health coverage and depression screening under the Affordable Care Act.

The research team is currently working on developing decision support intervention tools (DESIs) such as Option GridsTM decision aids to help increase shared decision making among people with depression that may reduce the information gap between consumers and clinicians.

“There is a lot that could be done to help patients and health care providers communicate more effectively and to ultimately help people with depression get the treatment they want,” Barr said.

About this psychology and depression research

Source: The Dartmouth Institute
Image Source: The image is credited to Joan M. Mas
Original Research: Abstract for “Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression” by Paul J Barr, Rachel C Forcino, Manish Mishra, Rachel Blitzer, Glyn Elwyn in BMJ Open. Published online January 8 2016 doi:10.1136/bmjopen-2015-009585


Abstract

Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression

Objective To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care.

Design 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 ‘important features’ in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores.

Setting Online cross-sectional surveys fielded in September to December 2014.

Participants We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA.

Primary outcome measures Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM.

Results 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was ‘Will the treatment work?’ Clinicians were aware of consumers’ priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores.

Conclusions While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve levels of SDM and provide clinicians and consumers with a tool to address the existing misalignment in information priorities.

“Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression” by Paul J Barr, Rachel C Forcino, Manish Mishra, Rachel Blitzer, Glyn Elwyn in BMJ Open. Published online January 8 2016 doi:10.1136/bmjopen-2015-009585

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