A Clinician/Patient Disconnect May Hamper Effective Depression Care

A national survey of depression patients and clinicians who treat depression has uncovered a disconnect in treatment priorities that may be impairing the quality and success of depression care.

Survey results suggest that clinicians and patients think differently about the information patients should have to make decisions about depression treatment options.

The study, conducted by researchers from the Dartmouth Institute of Health Policy & Clinical Practice, was published in the January 2016 edition of the journal “BMJ Open”. In late 2014, nearly 1,000 Americans who are currently undergoing or have previously sought treatment for depression, along with almost 250 clinicians who had recently treated depression, were asked to rate common features of depression treatment according to their perceptions of how important they are to therapeutic success.

Not on the same page

Answers from the two groups revealed that although they agreed on the highest priority, opinions diverged considerably beyond that. “The good news is that both patients and clinicians who treat depression consider whether a treatment will work to be the most important priority,” said lead study author Dr. Paul Barr, an assistant professor at the Dartmouth Institute. “However, while consumers place a high priority on cost and insurance information, clinicians do not always prioritize this as highly.”

“We found that although many healthcare providers realize that their patients want to know how much a particular treatment costs and if insurance will cover it, they don’t seem to cover these topics with their patients,” Barr noted, adding that lack of communication on those topics could be due to time limitations during clinical visits, the difficulty of identifying patient-specific costs, and a belief that medical decisions should be based exclusively on needs, not costs.

But costs and insurance considerations can be a source of considerable stress for patients. “The cost of treatment has a significant impact on a patient’s financial stability, which can impact their well-being and whether they actually begin a treatment, especially if they cannot afford it,” said Barr.

A communication gap

The survey also assessed patients’ perceptions of a practice known as shared decision making (SDM), a collaborative process that allows patients and their providers to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences. Just 18 percent of the patient respondents reported a high level of SDM with their clinicians, and that impression, coupled with the disconnect related to treatment priorities, may adversely affect the quality of depression care, according to the report.

“Shared decision making aims to generate greater alignment between patient preferences and chosen treatments with a view to improving subsequent treatment outcomes. When individuals with depression are involved in SDM, treatment selection, adherence, satisfaction, and outcomes are improved,” the authors write. There is hope that enhanced attention to SDM needs could make the situation better. “Development of a decision support intervention based on our findings can improve levels of SDM and provide clinicians and consumers with a tool to address the existing misalignment in information priorities,” they assert.

Armed with the new information provided by the survey, the Dartmouth group is working to develop decision support intervention tools, known as DESIs, to help bridge the gap uncovered by the data. DESIs have shown promising results in other clinical settings, but few exist for depression patients. The researchers report that they are currently in the process of developing a DESI based on their findings and are testing its understandability, comprehensiveness, and acceptability through interviews with consumers, clinicians, and the general public.

The bottom line, according to Barr, is that, “There is a lot that could be done to help patients and health care providers communicate more effectively and to ultimately help people with depression get the treatment they want.”