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Effectiveness of structured patient-clinician communication with a solution focused approach (DIALOG+) in community treatment of patients with psychosis - a cluster randomised controlled trial

Effectiveness of structured patient-clinician communication with a solution focused approach (DIALOG+) in community treatment of patients with psychosis - a cluster randomised controlled trial
Effectiveness of structured patient-clinician communication with a solution focused approach (DIALOG+) in community treatment of patients with psychosis - a cluster randomised controlled trial
Background
Large numbers of patients with psychosis have regular meetings with key clinicians in the community. There is little evidence on how these meetings should be conducted to be therapeutically effective. DIALOG, a computer mediated procedure, was shown to improve outcomes in a European multi-centre trial. DIALOG structures the patient-clinician communication and makes it patient-centred, but does not guide clinicians as to how to respond to patients’ concerns. DIALOG has been further developed into DIALOG+, which uses advanced software and, additionally, provides a four step approach - based on a solution focused model - for addressing patients’ concerns. We designed a cluster randomised controlled trial to test the effectiveness of DIALOG+ in improving treatment outcomes of patients with psychosis in the community.

Methods/design
Key workers are recruited from community mental health teams in East London and randomly allocated to either the intervention or control group. Out of their case loads, we identify patients with schizophrenia (F 20–29) and a moderate or lower level of subjective quality of life (MANSA score <5), who are treated according to the allocation of their key workers. Key workers in the intervention group are trained in using DIALOG+ and use it with each patient over a six-month period. Control patients rate their satisfaction with life and treatment on a tablet to control for the effect of regular ratings and the use of modern technology. We are recruiting up to 42 key workers to reach a total sample size of 180 patients. Clinical and social outcomes including costs are assessed after 3, 6 and 12 months. Primary outcome is subjective quality-of-life at 6 months.

Discussion
The trial aims to evaluate the effectiveness of a novel intervention (DIALOG+) which uses modern technology to support routine patient-clinician meetings in community care, makes the communication patient centred and guides patients and clinicians to address concerns. DIALOG+ is a generic and widely applicable intervention. If shown as effective, it can be used to improve outcomes of community care on a large scale, ensuring that routine encounters are therapeutically effective. DIALOG+ can also be implemented across services at relatively low additional costs.
1471-244X
173
Priebe, S.
37449b40-896c-49c1-944d-65fd11c72578
Kelley, L.
ab5a519d-0e09-4a0c-903d-3410fce6065b
Golden, E.
34346871-53b1-48a5-8534-0d7813b93dfd
McCrone, P.
46acaeda-f726-49ca-b83a-0ed61cac7f83
Kingdon, D.
14cdc422-10b4-4b2d-88ec-24fde5f4329b
Rutterford, C.
597c15a8-669f-4dd1-aad0-46e38df6d085
McCabe, R.
a3fda569-5073-4697-bc9f-650948a396dc
Priebe, S.
37449b40-896c-49c1-944d-65fd11c72578
Kelley, L.
ab5a519d-0e09-4a0c-903d-3410fce6065b
Golden, E.
34346871-53b1-48a5-8534-0d7813b93dfd
McCrone, P.
46acaeda-f726-49ca-b83a-0ed61cac7f83
Kingdon, D.
14cdc422-10b4-4b2d-88ec-24fde5f4329b
Rutterford, C.
597c15a8-669f-4dd1-aad0-46e38df6d085
McCabe, R.
a3fda569-5073-4697-bc9f-650948a396dc

Priebe, S., Kelley, L., Golden, E., McCrone, P., Kingdon, D., Rutterford, C. and McCabe, R. (2013) Effectiveness of structured patient-clinician communication with a solution focused approach (DIALOG+) in community treatment of patients with psychosis - a cluster randomised controlled trial. BMC Psychiatry, 13, 173. (doi:10.1186/1471-244X-13-173).

Record type: Article

Abstract

Background
Large numbers of patients with psychosis have regular meetings with key clinicians in the community. There is little evidence on how these meetings should be conducted to be therapeutically effective. DIALOG, a computer mediated procedure, was shown to improve outcomes in a European multi-centre trial. DIALOG structures the patient-clinician communication and makes it patient-centred, but does not guide clinicians as to how to respond to patients’ concerns. DIALOG has been further developed into DIALOG+, which uses advanced software and, additionally, provides a four step approach - based on a solution focused model - for addressing patients’ concerns. We designed a cluster randomised controlled trial to test the effectiveness of DIALOG+ in improving treatment outcomes of patients with psychosis in the community.

Methods/design
Key workers are recruited from community mental health teams in East London and randomly allocated to either the intervention or control group. Out of their case loads, we identify patients with schizophrenia (F 20–29) and a moderate or lower level of subjective quality of life (MANSA score <5), who are treated according to the allocation of their key workers. Key workers in the intervention group are trained in using DIALOG+ and use it with each patient over a six-month period. Control patients rate their satisfaction with life and treatment on a tablet to control for the effect of regular ratings and the use of modern technology. We are recruiting up to 42 key workers to reach a total sample size of 180 patients. Clinical and social outcomes including costs are assessed after 3, 6 and 12 months. Primary outcome is subjective quality-of-life at 6 months.

Discussion
The trial aims to evaluate the effectiveness of a novel intervention (DIALOG+) which uses modern technology to support routine patient-clinician meetings in community care, makes the communication patient centred and guides patients and clinicians to address concerns. DIALOG+ is a generic and widely applicable intervention. If shown as effective, it can be used to improve outcomes of community care on a large scale, ensuring that routine encounters are therapeutically effective. DIALOG+ can also be implemented across services at relatively low additional costs.

Text
BMC Psych 2013 13.173.pdf - Version of Record
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Published date: 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 367273
URI: http://eprints.soton.ac.uk/id/eprint/367273
ISSN: 1471-244X
PURE UUID: b8f7fdcb-64e1-4edf-942b-242c370dc257

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Date deposited: 29 Jul 2014 12:16
Last modified: 30 Jul 2019 18:44

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Contributors

Author: S. Priebe
Author: L. Kelley
Author: E. Golden
Author: P. McCrone
Author: D. Kingdon
Author: C. Rutterford
Author: R. McCabe

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