S42. QUALITATIVE ANALYSIS OF CLINICIANS’ PERSPECTIVES ON THE USE OF A COMPUTERIZED DECISION AID IN THE TREATMENT OF PSYCHOTIC DISORDERS
Authors: Roebroek Lukas , Bruins Jojanneke , Knegtering Henderikus , Delespaul Philippe , Boonstra Albert , Castelein Stynke 
Published: May 2020

Abstract

Background
People with a psychotic illness have varying care needs in different areas of their life, often over prolonged periods. Symptomatic, medical or psychosocial problems can go undetected and therefore remain untreated. Routine outcome monitoring (ROM) is way to systematically monitor these problems. In addition, multidisciplinary guidelines and standards of care provide suitable evidence-based treatments for most care needs. However, the integration of ROM results and the implementation of guidelines in daily clinical care can still be improved. Clinical decision aids (CDAs) can be used as tools to ingrate ROM results and to implement guidelines into daily clinical practice within psychosis care. Despite the effectiveness of CDAs in different medical disciplines, their use in psychiatric care is rare. Our goal is to successfully implement a clinical decision aid in psychosis care, which can promote the use of evidence-based treatments, based on care need identified by ROM.

Methods
We developed TReatment E-AssisT (TREAT), a computerized clinical decision aid that combines ROM outcomes with evidence-based guidelines in order to generate personalised treatment recommendations. A pilot study was conducted to test the feasibility for implementation in daily clinical practice. Currently, a multicenter trial is conducted to investigate the effects of TREAT on day-to-day patient care. As part of this trial, we have conducted a qualitative analysis of clinicians’ experiences of working with the TREAT application. We interviewed eight psychiatrist and five nurse practitioners who had worked with the application multiple times with different patients during their consultations. Our goal was to gain insight in the way clinicians used TREAT, to uncover implementation barriers and facilitators and to find ways to improve the application for future use. We analysed the data by using a thematic analysis.

Results
The five themes we identified from the data were; the visual structuring of ROM results, guideline based treatment recommendations, facilitating and obstructing factors, patient effects and shared decision-making. We also identified a clear distinction in the general appraisal of TREAT. Eight clinicians experienced the application as overall benefiting their clinical encounters, while five experienced no additional benefits or sometimes even a negative impact on their daily clinical practice. Clinicians with a more favourable opinion towards TREAT experienced the visual structuring of ROM results and the guideline based recommendations as more positive as opposed to the clinicians with a less favourable opinion. This in turn influenced their clinical reasoning and in some cases their clinical decisions. Different facilitating and obstructing factors were identified, for example; treatment offer within teams, time management and supporting staff. The application did not work equally well for all patient. However, all clinicians agreed that TREAT positively affected shared decision-making during consolations.

Discussion
With TREAT, we have developed an innovative digital tool in psychosis care. A majority of clinicians found the application beneficial for their daily clinical practice. However not all clinicians experienced additional benefits and not all patients seemed fit for TREAT. We identified different barriers and facilitators for implementation and received multiple point of improvement for the future development of the application.