SA134. Applying Skills Training to Improve Shared Decision-Making in Serious Mental Illness

Abstract

Background: Shared decision-making (SDM) is an essential aspect of evidence-based and recovery-oriented care for people with schizophrenia and other serious mental illnesses (SMI), associated with a range of positive outcomes (e.g., improved treatment adherence, quality of life). In this study, we refned and pilot tested a new group skills training modality in an effort to increase patients' ability to engage in SDM. Methods: Patients and providers gave feedback on the skills training modal-ity, Collaborative Decision Skills Training (CDST), and their qualitative feedback was analyzed and used to refne the manual. People with psy-chotic spectrum disorders participated in 3 pilot groups at a day program for SMI. Feasibility and initial outcome data were collected to understand viability and potential of CDST. Results: Qualitative data were analyzed using content analysis in NVivo. Ten revisions were made based on qualitative feedback. Four of 5 feasibil-ity-associated hypotheses were supported. Average attendance was 89.1%, and 11.11% (2 of 18) participants dropped out. Participants reported being satisfed with the group (91.76% average satisfaction score). Therapists met fdelity (90.07% average fdelity score) and improved in fdelity over time. Participants did not complete homework as often as expected: Average full completion was 32.5% and average partial completion was 21.4%. Additionally, linear regression found that therapist assessment of patient skills increased over time, (β =.445, t = 3.222, P =.002), R2=.198, F(1, 42) = 10.379, P =.002. A further linear regression indicated that homework completion was associated with increased patient skills (β =.398, t = 2.516, P =.018), and time remained signifcant (β =.368, t = 2.330, P =.028), R2 =.220, F(2, 27) = 7.284, P =.003. Linear regression testing improvement in knowledge about SDM and CDST skills approached signifcance, (β =.221, t = 1.799, P =.077), R2 =.049, F(1, 63) = 3.237, P =.077. Conclusion: Analyses from the pilot test indicate that CDST is feasible. Additionally, preliminary outcome data suggest that CDST improves knowledge and skills targeted by the intervention. A larger trial of CDST is merited to understand proximal and distal outcomes of applying skills training to improve SDM in SMI. Future trials should target increased homework adherence, particularly as evidence indicates that better adherence was associated with improved SDM-related skills.