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

Emily B H Treichler^{1

2}, Borsika A Rabin^{3

4

5}, William D Spaulding⁶, Michael L Thomas^{7

8}, Michelle P Salyers⁹, Eric L Granholm^{7

10}, Amy N Cohen^#^{11

12}, Gregory A Light^#^{13

7}

Affiliations

¹ VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA. emily.treichler@gmail.com.
² Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA. emily.treichler@gmail.com.
³ Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
⁴ Center of Excellence in Stress and Mental Health, San Diego VA, La Jolla, CA, USA.
⁵ UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA.
⁶ Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.
⁷ Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA.
⁸ Department of Psychology, Colorado State University, Fort Collins, CO, USA.
⁹ Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA.
¹⁰ VA San Diego Psychology Service, San Diego, CA, USA.
¹¹ American Psychiatric Association, Los Angeles, CA, USA.
¹² Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
¹³ VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA.

^# Contributed equally.

PMID: 33781352
PMCID: PMC8005669
DOI: 10.1186/s40814-021-00820-4

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

Emily B H Treichler et al. Pilot Feasibility Stud. 2021.

. 2021 Mar 29;7(1):89.

doi: 10.1186/s40814-021-00820-4.

Authors

Affiliations

¹ VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA. emily.treichler@gmail.com.
² Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA. emily.treichler@gmail.com.
³ Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
⁴ Center of Excellence in Stress and Mental Health, San Diego VA, La Jolla, CA, USA.
⁵ UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA.
⁶ Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.
⁷ Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA.
⁸ Department of Psychology, Colorado State University, Fort Collins, CO, USA.
⁹ Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA.
¹⁰ VA San Diego Psychology Service, San Diego, CA, USA.
¹¹ American Psychiatric Association, Los Angeles, CA, USA.
¹² Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
¹³ VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA.

^# Contributed equally.

PMID: 33781352
PMCID: PMC8005669
DOI: 10.1186/s40814-021-00820-4

Abstract

Background: Collaborative 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.

Methods: In 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.

Discussion: This 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 registration: ClinicalTrials.gov Identifier: NCT04324944.

Keywords: Adaptation; Implementation science; Mixed methods; Participatory methods; Patient activation; Pilot; Recovery model; Schizophrenia; Shared decision-making.

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Conflict of interest statement

E.T. and W.S. are co-developers of the intervention studied, CDST, but receive no royalties associated with its use. M.S. is the primary developer of the primary outcome measure, the SDM-CS.

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References

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1. Bowersox NW, Visnic S, McCarthy J. Care for Veterans Health Administration Clients with Psychosis, Fiscal Year 2015: 17th annual report of the Veterans Health Administration National Psychosis Registry. 2016.
1. Rosen K, Garety P. Predicting recovery from schizophrenia: a retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophr Bull. 2005;31(3):735–750. doi: 10.1093/schbul/sbi017. - DOI - PubMed
1. Interdepartmental Serious Mental Illness Coordinating Committee . The way forward: federal action for a system that works for all people living with SMI and SED and their families and caregivers. 2017.

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

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

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