Evaluating clinical decision making
CDM refers to decisions and actions taken during patient treatment. Decision making in chronic conditions such as SMI should take into account long-term disease management, and usually involves more than one carer. To evaluate the quality of CDM in such cases, the EU-funded project 'Clinical decision making and outcome in routine care for people with severe mental illness' (CEDAR) developed instruments to monitor vital elements of CDM from both patient and staff perspectives, and put to use these instruments to examine the effect of CDM on outcome. The study assessed the style of CDM by focusing on preferences regarding participation in decision-making (passive vs. shared vs. active) and the need for the information provided The CDM involvement and satisfaction (CDIS) instrument examined involvement and satisfaction with decision making as experienced in actual treatment sessions. Finally, the CDM in routine care (CDRC) measure evaluated key CDM aspects such as content, context, and implementation. The instruments were provided in four other languages apart from English and the study was conducted in six centres throughout Europe. Results indicated that certain staff clinical decision making style substantially affected outcome (patient-rated number of unmet needs). Decision making style of staff is a prime candidate for future targeted interventions, indicating a shift from shared to active involvement of patients. By specifying the relationship between CDM and outcome, the CEDAR study helps to optimise the delivery of mental health care to European citizens.
