Shared Decision Making in mental health care using Routine Outcome Monitoring (ROM) as a source of information (WC2015-051)

Shared Decision Making in mental health care using Routine Outcome Monitoring (ROM) as a source of information


Starting date: 15/04/2015

Shared Decision Making (SDM)
However more research to Shared Decision Making (SDM) is clearly needed for clients with mental health disorders, there is preliminary evidence for SDM as a method to improve: knowledge of clients about their illness, perceived involvement of clients in decision making, patient-participation,  patient satisfaction, guideline concordant care, attendance and retention in treatment and reduction of decisional conflict (Malm et al. 2003; Patel et al. 2008; Loh et al. 2007a en b; Hamann et al. 2006; Clever et al. 2006, Westerman et al. 2013; Ludman 2003). Despite the promising results of SDM and the value of the keywords autonomy and equality in mental health care, decisions about treatment options are regularly taken in a paternalistic way (Patel et al. 2008; Helmus et al. 2011). Generally clients prefer greater participation than they are offered (Adams et al. 2007; Swenson et al. 2004; De las Cuevas; 2014).

Routine Outcome Monitoring (ROM)
Routine Outcome Monitoring (ROM) is described as: regular measurements of clients’ progress in clinical practice, using standardized instruments, aiming to evaluate and, if necessary, adapt treatment. Clients, close relatives and/or practitioners fill out measurement instruments at the beginning of treatment, during treatment and at the end of treatment. Subsequently, practitioners and clients are provided with feedback about the response to treatment (De Jong et al. 2012; Lambert, 2007; Sonsbeek et al. 2014).
In a review Carlier et al. (2012) found that feedback with ROM results mainly has positive effects on the behaviour of professionals with respect to faster and more adequate screening, frequent and effective communication between client and therapist, and, if necessary, swifter adjustment of treatment. ROM appears especially effective for the monitoring of clients who are not doing well in therapy, the so called Not-On-Track (NOT) cases (Lambert et al. 2003, Sapyta et al. 2005).
ROM is primarily intended as a tool for the mental health care client and provider to evaluate the extent of progress or decline of treatment outcomes and based on this to choose the most appropriate treatment option. Despite this intention ROM is still underused in the consultation between client and practitioner and should regain its clinical focus with benefits for the treatment of the client (Trimbos-institute, 2015; Delespaul, 2015; Verbraak et al. 2015).

SDM with ROM as a source of information
Until now SDM and ROM have been presented as separate innovations in Dutch mental health care. This, in spite of the fact that both interventions aim to empower the client in the treatment process and provide him/her with good quality information in order to participate in the decision making process.
One of the purposes of the Dutch Mental Health Care Routine Outcome Monitoring (ROM) Quality Improvement Collaborative (QIC), funded by the Dutch Network for Quality Development in mental health care, is to implement ROM in daily clinical practice as a source of information during the Shared Decision Making (SDM) process about the treatment plan, between the client and mental health care provider.