Abstract
BackgroundClinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery.MethodsData derived from an observational cohort study “Clinical decision making and outcome in routine care for people with severe mental illness” (CEDAR). Adults (aged 18–60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change.ResultsParticipants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15–2.94) or passive (OR = 1.71, 95% CI = 1.00–2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery.ConclusionsPatient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
Highlights
Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction
Stages of recovery We investigated the adequate number of courses of recovery by means of the number of classes representing a certain stage of recovery
Each stage of recovery maps toa certain response pattern of STORI items (e. g. being on a low recovery stage means high values in Moratorium items and lower values in other items)
Summary
Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. Best available evidence indicates the key processes involved in recovery which are Connectedness (“community integration” in North America, “social inclusion” in the UK, continental Europe and Australia), Hope and optimism about the future, a positive non-stigmatised Identity, Meaning in life, and Empowerment—the CHIME Framework [3]. This framework has been validated internationally [9] and in current mental health service users [10], and the five processes are all potential target outcome domains for mental health services, yet the current evidence base and practice does not support this orientation. Evidence about the relationship between clinical practice and recovery support is needed
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