A SURVEY OF PATIENT– PHYSICIAN COMMUNICATION REGARDING TREATMENT PROSPECTS AND GOAL SETTING IN THE TREATMENT OF MAJOR DEPRESSIVE DISORDER IN JAPAN
Authors: Tsuboi *Takashi , Nakayama Takeo , Horie Junko , Tokuda Fumie , Moriguchi Yoshiya , Hoshino Tatsuya 
Published: February 2025

Abstract

Background
Achieving personal recovery is a crucial objective in the treatment of major depressive disorder (MDD). To attain personal recovery, effective communication between patients and physicians regarding MDD treatment prospects and goals is considered essential, as each patient has individual priorities and aspirations. However, the extent of patient participation in such communication with their physicians and the nature of goal setting in clinical MDD treatment remain unclear. Furthermore, no previous reports have investigated whether the quality of communication or goal setting can impact outcomes.

Aims & Objectives
The primary aim of this study was to elucidate the current status of patient– physician communication concerning MDD treatment prospects and to examine the relationship between the presence of such communication and the quality of goal setting with outcomes.

Method
A web-based survey was distributed among members of the Pep-Up service, managed by JMDC Inc. Patients aged 18 years and older who had self-reported visit for MDD and had their MDD diagnosis confirmed through health insurance claims data (ICD10 code: F32-F33) were selected for analysis. The survey collected information on background demographics, MDD symptoms, communication patterns, and goal setting for MDD treatment. Trust in the physician and treatment satisfaction were evaluated as outcomes in this study using the Wake Forest Physician Trust scale (TRUST) and a 5-point rating, respectively. The quality of goal setting was assessed objectively using the SMART (Specific, Measurable, Achievable, Realistic, Timebound) score, which was originally designed by us.

Results
Among the 55,100 respondents to the questionnaire, 466 met the inclusion criteria. Of these 466 patients, 387 (83%) received antidepressant treatment. Among the respondents, 326 patients (70%) reported engaging in communication with their physicians about treatment prospects (Com+ group), whereas the remainder did not (Com- group). A total of 280 patients reported setting symptom-based goals, of which 239 patients set personal goals in collaboration with their physicians. Trust in the physician and treatment satisfaction tended to be higher in the Com+ group compared with those in the Com- group (median TRUST: 70 vs. 50; Treatment satisfaction: 5 vs. 4). Correlation coefficients between the SMART score and TRUST or treatment satisfaction were 0.27 and 0.38, respectively. In the Com+ group, higher SMART score levels for treatment goals were associated with increased levels of trust in the physician and treatment satisfaction.

Discussion & Conclusion
This study provides insight into the current landscape of patient– physician communication regarding treatment prospects and goal setting in MDD treatment. Our findings suggest that both the presence of patient– physician communication regarding treatment prospects and goal setting, as well as the quality of goal setting represented by high SMART score levels, may be positively associated with favorable outcomes, including increased trust in physicians and treatment satisfaction.