Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

BACKGROUND:At least 100,000 patients with schizophrenia receive care from community mental health teams (CMHTs) in England. These patients have regular meetings with clinicians, who assess them, engage them in treatment and co-ordinate care. As these routine meetings are not commonly guided by research evidence, a new intervention, DIALOG, was previously designed to structure consultations. Using a hand-held computer, clinicians asked patients to rate their satisfaction with eight life domains and three treatment aspects, and to indicate whether or not additional help was needed in each area, with responses being graphically displayed and compared with previous ratings. In a European multicentre trial, the intervention improved patients’ quality of life over a 1-year period. The current programme builds on this research by further developing DIALOG in the UK. RESEARCH QUESTIONS:(1) How can the practical procedure of the intervention be improved, including the software used and the design of the user interface? (2) How can elements of resource-oriented interventions be incorporated into a clinician manual and training programme for a new, more extensive ‘DIALOG+’ intervention? (3) How effective and cost-effective is the new DIALOG+ intervention in improving treatment outcomes for patients with schizophrenia or a related disorder? (4) What are the views of patients and clinicians regarding the new DIALOG+ intervention? METHODS:We produced new software on a tablet computer for CMHTs in the NHS, informed by analysis of videos of DIALOG sessions from the original trial and six focus groups with 18 patients with psychosis. We developed the new ‘DIALOG+’ intervention in consultation with experts, incorporating principles of solution-focused therapy when responding to patients’ ratings and specifying the procedure in a manual and training programme for clinicians. We conducted an exploratory cluster randomised controlled trial with 49 clinicians and 179 patients with psychosis in East London NHS Foundation Trust, comparing DIALOG+ with an active control. Clinicians working as care co-ordinators in CMHTs (along with their patients) were cluster randomised 1 : 1 to either DIALOG+ or treatment as usual plus an active control, to prevent contamination. Intervention and control were to be administered monthly for 6 months, with data collected at baseline and at 3, 6 and 12 months following randomisation. The primary outcome was subjective quality of life as measured on the Manchester Short Assessment of Quality of Life; secondary outcomes were also measured. We also established the cost-effectiveness of the DIALOG intervention using data from the Client Service Receipt Inventory, which records patients’ retrospective reports of using health- and social-care services, including hospital services, outpatient services and medication, in the 3 months prior to each time point. Data were supplemented by the clinical notes in patients’ medical records to improve accuracy. We conducted an exploratory thematic analysis of 16 video-recorded DIALOG+ sessions and measured adherence in these videos using a specially developed adherence scale. We conducted focus groups with patients (n = 19) and clinicians (n = 19) about their experiences of the intervention, and conducted thematic analyses. We disseminated the findings and made the application (app), manual and training freely available, as well as producing a protocol for a definitive trial. RESULTS:Patients receiving the new intervention showed more favourable quality of life in the DIALOG+ group after 3 months (effect size: Cohen’s d = 0.34), after 6 months (Cohen’s d = 0.29) and after 12 months (Cohen’s d = 0.34). An analysis of video-recorded DIALOG+ sessions showed inconsistent implementation, with adherence to the intervention being a little over half of the possible score. Patients and clinicians from the DIALOG+ arm of the trial reported many positive experiences with the intervention, including better self-expression and improved efficiency of meetings. Difficulties reported with the intervention were addressed by further refining the DIALOG+ manual and training. Cost-effectiveness analyses found a 72% likelihood that the intervention both improved outcomes and saved costs. LIMITATIONS:The research was conducted solely in urban east London, meaning that the results may not be broadly generalisable to other settings. CONCLUSIONS:(1) Although services might consider adopting DIALOG+ based on the existing evidence, a definitive trial appears warranted; (2) applying DIALOG+ to patient groups with other mental disorders may be considered, and to groups with physical health problems; (3) a more flexible use with variable intervals might help to make the intervention even more acceptable and effective; (4) more process evaluation is required to identify what mechanisms precisely are involved in the improvements seen in the intervention group in the trial; and (5) what appears to make DIALOG+ effective is that it is not a separate treatment and not a technology that is administered by a specialist; rather, it changes and utilises the existing therapeutic relationship between patients and clinicians in CMHTs to initiate positive change, helping the patients to improve their quality of life. FUTURE RESEARCH:Future studies should include a definitive trial on DIALOG+ and test the effectiveness of the intervention with other populations, such as people with depression. TRIAL REGISTRATION:Current Controlled Trials ISRCTN34757603. FUNDING:The National Institute for Health Research Programme Grants for Applied Research programme

Information Outlook, May 2004

Volume 8, Issue 5https://scholarworks.sjsu.edu/sla_io_2004/1004/thumbnail.jp

Collaborative hybrid agent provision of learner needs using ontology based semantic technology

© Springer International Publishing AG 2017. This paper describes the use of Intelligent Agents and Ontologies to implement knowledge navigation and learner choice when interacting with complex information locations. The paper is in two parts: the first looks at how Agent Based Semantic Technology can be used to give users a more personalised experience as an individual. The paper then looks to generalise this technology to allow users to work with agents in hybrid group scenarios. In the context of University Learners, the paper outlines how we employ an Ontology of Student Characteristics to personalise information retrieval specifically suited to an individual’s needs. Choice is not a simple “show me your hand and make me a match” but a deliberative artificial intelligence (AI) that uses an ontologically informed agent society to consider the weighted solution paths before choosing the appropriate best. The aim is to enrich the student experience and significantly re-route the student’s journey. The paper uses knowledge-level interoperation of agents to personalise the learning space of students and deliver to them the information and knowledge to suite them best. The aim is to personalise their learning in the presentation/format that is most appropriate for their needs. The paper then generalises this Semantic Technology Framework using shared vocabulary libraries that enable individuals to work in groups with other agents, which might be other people or actually be AIs. The task they undertake is a formal assessment but the interaction mode is one of informal collaboration. Pedagogically this addresses issues of ensuring fairness between students since we can ensure each has the same experience (as provided by the same set of Agents) as each other and an individual mark may be gained. This is achieved by forming a hybrid group of learner and AI Software Agents. Different agent architectures are discussed and a worked example presented. The work here thus aims at fulfilling the student’s needs both in the context of matching their needs but also in allowing them to work in an Agent Based Synthetic Group. This in turn opens us new areas of potential collaborative technology

Special Libraries, May-June 1977

Volume 68, Issue 5-6https://scholarworks.sjsu.edu/sla_sl_1977/1004/thumbnail.jp

Special Libraries, July 1978

Volume 69, Issue 7https://scholarworks.sjsu.edu/sla_sl_1978/1005/thumbnail.jp

Tracking Chart 2005 Eddie Bauer, China 02021526D

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.FLA_2005_Eddie_Bauer_TC_China_02021526D.pdf: 14 downloads, before Oct. 1, 2020

Tracking Chart 2005 Puma, China 02021526D

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.FLA_2005_Puma_TC_Vietnam_02021526D.pdf: 9 downloads, before Oct. 1, 2020

Special Libraries, August 1980

Volume 71, Issue 8https://scholarworks.sjsu.edu/sla_sl_1980/1006/thumbnail.jp

Deafness-Related Materials: Collection Development and Information Retrieval

published or submitted for publicatio

Tracking Chart 2008 Puma, China 02021526DV

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.FLA_2008_Puma_TC_China_02021526DV.pdf: 15 downloads, before Oct. 1, 2020