Abstract
BackgroundA considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness.Methods/DesignThe study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome.DiscussionThe results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe.Trial registerISRCTN75841675.
Highlights
A considerable amount of research has been conducted on clinical decision making (CDM) in shortterm physical conditions
With its explicit focus on the patient role in CDM, CEDAR will contribute to strengthening the service user perspective
This project will substantially add to improving the practice of CDM in mental health care across Europe
Summary
Almost all EU member states have undergone substantial psychiatric reforms. Strengthen the clinical governance process for improvements in clinical decision making by specifying the relationship between CDM and outcome, best practices of clinical decision making in the care for people with severe mental illness will be made available to stakeholders (patients, clinician, health care funders) and clinical governance will be strengthened. The central target will be to provide a differentiated answer to the question, “What amount of patient involvement is most beneficial (i.e. substantially related to patient satisfaction, patient behaviour, and clinical outcome) in what kind of clinical decision?” This will be done on a general level, and take into account variations in service provision between the participating centres in Germany, UK, Italy, Hungary, Denmark, and Switzerland This will lead to a set of good practice points which will give guidance on how to improve CDM in the service provision for people with SMI. List of abbreviations CEDAR: Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (study acronym); CDIS CEDAR: Clinical Decision Making Involvement and Satisfaction Scale (instrument); CDM: Clinical decision making; CDMS CEDAR: Clinical Decision Making Style Scale (instrument); CDRC CEDAR: Clinical Decision Making in Routine Care Scale (instrument); SMI: Severe mental illness; ANOVA: Analysis of Variance
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
