Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis

Emily B H Treichler,Michelle P Salyers,Eric L Granholm,Gregory A Light,Amy N Cohen,Borsika A Rabin,Michael L Thomas,William D Spaulding

doi:10.1186/s40814-021-00820-4

Abstract

BackgroundCollaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans.MethodsIn aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness.DiscussionThis study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs.Trial registrationClinicalTrials.gov Identifier: NCT04324944

Highlights

Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers
Lessons learned from this study will be disseminated to similar mental health clinics to support evidence-based adaptation and increase collaborative decision-making between patients and providers
In fiscal year 2018, 68% of veterans at this Psychosocial Rehabilitation and Recovery Center (PRRC) endorsed that one of their top goals is managing physical and mental health care, and 55% endorsed that social skills and interaction was a top goal, indicating that Collaborative Decision Skills Training (CDST) could be a good fit for current veteran priorities

Summary

Methods

Setting and population Veterans receiving services through a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California will be recruited to participate. Over the course of two group meetings, facilitated by the first author, the ART members will provide feedback to inform initial development of the Service Delivery Manual and revisions to the Clinician Manual, to be used by providers of CDST during the open trial. Post-intervention and follow-up interviews will focus on veterans’ experience in CDST, any changes they have noticed in themselves during or following participating in the study, including in the outcomes of interest, and any changes they have made in how they approach treatment decision-making. Given that these interviews will be semi-structured, specific topics will vary based on individual veterans and other factors as the study evolves. This examination may help us understand variables to consider for stratification during future larger trials

Discussion

Background

Findings