Shared Decision-Making for Elderly Depressed Primary Care Patients
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      Shared decision-making (SDM), in contrast to traditional medical decision-making, involves a
      collaborative process where patients discuss personal values and preferences and clinicians
      provide information to arrive at an agreed upon treatment decision. The proposed study will
      evaluate the impact of a brief SDM nursing intervention among elderly, depressed primary care
      patient subjects in comparison to physician recommended Usual Care. The focus of the SDM
      intervention is to empower depressed patients and help them arrive at a treatment decision
      that can be successfully carried out.
    

Detailed description: 
      Shared Decision Making (SDM) may be particularly relevant for depressed individuals, as it
      seeks to enhance their autonomy and empowerment in a manner that directly addresses the
      helplessness and hopelessness associated with depression. Shared decision-making
      interventions are being developed for depression in primary care, but have yet to be
      adequately tested. It is also unknown whether the same premises regarding shared
      decision-making's ability to enhance autonomy and empowerment pertain to elderly populations.

      This randomized study will recruit elderly depressed primary care patient subjects and
      evaluate the impact of a three-session SDM nursing intervention on their (1) adherence to
      antidepressant medication or psychotherapy and on (2) their reduction in depressive symptoms.
      The comparison group will be physician-recommended Usual Care (UC). The focus of the SDM
      intervention is to empower elderly depressed primary care patients and help them efficiently
      arrive at a treatment decision that can be successfully implemented.

      The study randomizes physicians to provide their depressed patients with SDM or UC. A total
      of 210 elderly depressed patient subjects whose physicians recommend starting depression
      treatment, will receive either Shared Decision-Making (SDM) or the physician recommended
      Usual Care (UC) comparison condition. Participants will be assessed at baseline and at weeks
      4, 8, 12, and 24 to determine treatment adherence and depressive status. Nurses currently
      employed by the participating physicians will administer the SDM intervention.
    

Intervention name(s): Shared Decision Making; Usual Care
Intervention type(s): Behavioral; Other
Intervention description(s): Shared decision-making, in contrast to traditional medical decision-making, involves a collaborative process where patients discuss personal values and preferences and clinicians provide information to arrive at an agreed upon treatment decision. The focus of the intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that can be successfully implemented.; Usual Care reflects the standard of care in primary care practice: following physician recommendation for treatment. Physicians will recommend some form of depression treatment. This may take the form of an antidepressant prescription or psychotherapy referral. The physician will encourage patients to telephone with any questions. Following the treatment recommendation provided to the patient, the physician will provide care as usual.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research