A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers
Open accessAbstract
BACKGROUND: Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers. METHODS: The CDST was developed in Oxford. To tailor treatments at an individual level, the CDST combines the best available evidence from the scientific literature with patient preferences and values, and with patient medical profile to generate personalised clinical recommendations. We conducted three focus groups comprising of three different participant types: consultant psychiatrists, participants with a mental health diagnosis and/or experience of caring for someone with a mental health diagnosis, and primary care practitioners and nurses. Each 1-h focus group started with a short visual demonstration of the CDST. To standardise the discussion during the focus groups, we used the same topic guide that covered themes relating to the acceptability and usability of the CDST. Focus groups were recorded and any identifying participant details were anonymised. Data were analysed thematically and managed using the Framework method and the constant comparative method. RESULTS: The focus groups took place in Oxford between October 2016 and January 2017. Overall 31 participants attended (12 consultants, 11 primary care practitioners and 8 patients or carers). The main themes that emerged related to CDST applications in clinical practice, communication, conflicting priorities, record keeping and data management. CDST was considered a useful clinical decision support, with recognised value in promoting clinician-patient collaboration and contributing to the development of personalised medicine. One major benefit of the CDST was perceived to be the open discussion about the possible side-effects of medications. Participants from all the three groups, however, universally commented that the terminology and language presented on the CDST were too medicalised, potentially leading to ethical issues around consent to treatment. CONCLUSIONS: The CDST can improve communication pathways between patients, carers and clinicians, identifying care priorities and providing an up-to-date platform for implementing evidence-based practice, with regard to prescribing practices.
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When an intervention was used as part of ongoing in-person therapy, the way therapists used or were willing to use it influenced participants' engagement.
“If an intervention was used as part of ongoing in-person therapy, the way that therapists used or were willing to use an intervention influenced participants’ engagement with an intervention [84,103,127,150,169,212,243].”
From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [169]
The Results (Communication; page unavailable) report that a clinician’s response to patients using the decision tool and trust in the clinician–patient relationship could affect shared decision-making. The Discussion likewise says collaboration depends on that relationship. The paper does not report participants’ engagement with an intervention during ongoing in-person therapy, so the claim extends beyond its focus-group findings. (LLM, conf=0.80)
Experimental — accuracy not yet measuredContent presented with limited jargon or technical language makes information relevant and in a language suitable to the user.
“and content presented with limited jargon or technical language [169].”
From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [169]
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- Authors
- Henshall, C., Marzano, L., Smith, K., Attenburrow, M.-J., Puntis, S., Zlodre, J., Kelly, K., Broome, M. R., Shaw, S., Barrera, A., Molodynski, A., Reid, A., Geddes, J. R., & Cipriani, A.
- Affiliations
- Oxford Brookes University (GB)
- Middlesex University London (GB)
- Oxford Health NHS Foundation Trust (GB)
- Warneford Hospital (GB)
- Corresponding author
- Cipriani, Andrea
- ORCID
- Venue
- BMC Psychiatry
- Published
- 2017-07-21
- Volume
- 17
- Issue
- 1
- Pages
- 265-265
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC5521138
- OpenAlex
- W2724876318
- Cited by
- 41
- References
- 25
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 6 · 2021: 3 · 2020: 2 · 2019: 6 · 2018: 1
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Middlesex University Research Repository (Middlesex University Of London) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
- Radar (Oxford Brookes University) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- clinical decision support systems, web-based decision support, personalized medicine, acceptability, usability, clinician-patient communication, caregivers, adverse drug reactions, evidence-based prescribing, patient preferences, informed consent, primary care physicians
- MeSH terms
- Consultants, Decision Making, Humans, Pilot Projects, Psychiatry, Caregivers, Focus Groups, Disease Management, Decision Support Systems, Clinical, Needs Assessment, Internet
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