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Promoting Shared Decision-Making in Treatment for Psychotic Disorders with the iTandem Mobile App: A Feasibility and Acceptability Study (Preprint)
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Abstract
BACKGROUND
Strengthening shared decision-making in mental healthcare may improve quality of services and treatment outcomes, but its implementation in services for severe mental disorders is currently lacking.
OBJECTIVE
This study aims to explore the feasibility and acceptability of the mobile app iTandem as a digital tool promoting shared decision-making in treatment for psychotic disorders. In addition, the study aims to investigate mechanisms that enable the intended effect of the app. iTandem is a mobile app developed as a therapy supplement that facilitates patient involvement in decisions regarding treatment goals and focus areas. It is designed for personalized use and contains eight optional modules: sleep, medication, recovery, mood, psychosis, activity, substance use, and feedback concerning therapy.
METHODS
Patients undergoing assessment or treatment for psychotic disorders and their clinicians were recruited to the study. The patients and the clinicians jointly used iTandem as part of the standard treatment in a six week-trial. Using a mixed methods design, feasibility and acceptability measures were assessed with descriptive statistics based on app usage data and pre- and post-intervention questionnaires, in addition to a reflexive thematic analysis of post-intervention interviews.
RESULTS
Nine patients and eight clinicians completed the trial. The participants evaluated iTandem as a user-friendly and acceptable tool, but there were considerable variations in how the app was integrated in treatment and in perceptions of its clinical value. The thematic analysis suggests that iTandem promoted shared decision-making by supporting cognition and shifting the patient role. It also identified scaffolding structures, an analogy of personalised support, as a precondition for the overall feasibility and acceptability of the intervention.
CONCLUSIONS
iTandem generally functioned as a feasible and acceptable digital promoter of shared decision-making in treatment for patients with psychotic disorders. Our findings suggest that non-clinical aspects, such as support structures, digital habits and personal styles of relating to others are important in evaluations of patients’ aptness for digitalised treatment. Future research should explore these general parameters further, as opposed to grouping potential users based on diagnoses and symptom severity.
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