Project Profile: Patient Decision Aid for Depression

PROJECT: Guide the development of an encounter-based decision aid for depression that can be seamlessly embedded into primary care clinics. The tool will facilitate routine depression screening while linking real-time decision support to patients who screen positive for depression.

METHODS:

  • Four focus groups (6-12 people each) including individuals with depression, members of the general public, and clinicians to inform the decision aid’s scope and identify facilitators and barriers to implementation
  • Participants recruited from Dartmouth-Hitchcock Nashua, Dartmouth-Hitchcock Medical Center (Lebanon), and Mental Health America
  • Usability testing of an on-line prototype of the tool to identify refinements for the decision aid development
  • A caregiver partner and consumer partner who contribute to study design, analysis, and sharing of the research findings

OBJECTIVES:

  • Assess views of end-users (individuals with depression and clinicians) about use of the depression decision aid in clinic, and desired features of the system
  • Evaluate functionality of existing on-line prototype (a longer, home-based version of the tool)
  • Assess users’ experiences through debriefing interviews

FINDINGS:

  • Clinicians thought that the decision aid process would be helpful in engaging patients with depression in their treatment
  • Through user testing, the study team was able to determine what model of the decision aid worked best for both patients and clinicians
  • Overall, patients, consumers, and clinicians were comfortable with the screening and decision-support processes

FUNDING: National Library of Medicine, Moore Foundation, Dartmouth SYNERGY.

RESEARCH TEAM: Michelle Dannenberg, John Carlo Bienvenida, Martha Bruce, Theresa Nguyen, Michelle Hinn, James Matthews, Patricia Laliberte, Stephen Bartels, Glyn Elwyn, Paul Barr (principal investigator).

“We believe that this kind of tool, made available on tablets for patients as they wait to see their physician and seamlessly embedded in clinic workflows, can have real impact.”

-Paul Barr, principal investigator

COLLABORATORS: Mental Health America, Dartmouth-Hitchcock Population Health Collaboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Substance Abuse and Mental Health Services Administration.

BACKGROUND:

With about 16 million adults in the U.S. having at least one major depressive episode each year, depression carries with it enormous social, financial, and health-related costs. Individuals with depression are often not adequately engaged in treatment decision-making, which negatively affects their care.

Digitized decision aid tools, which can be embedded within clinical workflows, may help. This project is informed by previous work done by Paul Barr and his colleagues that led to a paper-based version of the tool, which was well-liked and readily accepted when reviewed by clinicians and patients.

“I think one of the strengths of this research approach, in addition to being scientifically sound, is it includes perspectives from patients and family members. That’s very encouraging because it seems like an approach that is more likely to deliver meaningful results to the people that it’s supposed to help.”

– Jim Matthews, patient partner

NEXT STEPS:

The project team are applying for additional funding through the National Institute of Mental Health, which will allow them to continue developing the tool and broaden the scope of their research to an online community.

CONTACT: paul.j.barr@dartmouth.edu