Does it matter whether physicians' recommendations are given early or late in the decision-making process? An experimental study among patients with schizophrenia.

Objectives: Physicians' recommendations are seen as an essential component in many models of medical decision-making, including shared decision-making. It is, however, unclear at what time in the decision-making process the recommendation is best given, not to adversely influence patient preferences. Within the present study we wanted to evaluate at what time in the decision-making process a doctor's recommendation is best given, not to adversely influence patient preferences.

A "Mental-Health-at-the-Workplace" Educational Workshop Reduces Managers' Stigma Toward Depression.

Stigma and discrimination are important factors hindering people with mental health conditions to stay employed or successfully make their careers. We surveyed 580 German managers before and after visiting a "mental-health-at-the-workplace" educational workshop using the Depression Stigma Scale. The workshop significantly reduced stigma toward depression.

[Mental health at the workplace - the view of companies].

Objective: To assess the views of employees (human resource, works council, supervisors, and executives) of German business companies and administrations toward the issue of mental health at the workplace.

Methods: Cross sectional survey of N = 348 employees with staff responsibility.

Results: Employees of German companies see their colleagues as moderately mentally stressed.

Effects of a question prompt sheet on active patient behaviour: a randomized controlled trial with depressed outpatients.

Background: A deeper engagement into medical decision-making is demanded by treatment guidelines for patients with affective disorders. There is to date little evidence on what facilitates active behaviour of patients with depression. In general medicine 'question prompt sheets' (QPSs) have been shown to change patients' behaviour in the consultation and improve treatment satisfaction but there is no evidence for such interventions for mental health settings.

Psychiatrists' decision making between branded and generic drugs.

To study psychiatrists' decision making between generic and branded antipsychotics or antidepressants a hypothetical decision scenario involving decisions between branded and generic drugs was presented to a sample of German psychiatrists. Factors influencing this decision were identified using a regression analysis. n=410 Psychiatrists participated in the survey.

Surrogate decision making for patients with end-stage dementia.

Objective: We aim to explore how health surrogates of patients with dementia proceed in decision making, which considerations are decisive, and whether family surrogates and professional guardians decide differently.

Methods: We conducted an experimental vignette study using think aloud protocol analysis. Thirty-two family surrogates and professional guardians were asked to decide on two hypothetical case vignettes, concerning a feeding tube placement and a cardiac pacemaker implantation in patients with end-stage dementia.

Patient participation in medical and social decisions in Alzheimer's disease.

Objectives: To analyze the preferences of people with amnestic mild cognitive impairment (aMCI) and mild dementia in Alzheimer's disease (AD) regarding different aspects of healthcare-related decisions, to correlate these findings with different measures of decision-making capacity, and to explore the views of relatives and referring physicians.

Design: Cross-sectional survey.

Setting: University-based memory clinic in Munich, Germany.

"How to speak to your psychiatrist": shared decision-making training for inpatients with schizophrenia.

Objective: Involving patients with mental illness in shared decision making about their treatment has recently attracted attention, but existing interventions may insufficiently motivate or enable patients with schizophrenia to behave more actively. This study evaluated a new intervention.

Methods: In a pilot study 61 inpatients with schizophrenia or schizoaffective disorder from a psychiatric hospital in Germany were randomly assigned to receive shared decision-making training (N=32) or cognitive training (N=29, control condition).

How should patients behave to facilitate shared decision making--the doctors' view.

Objective: To study how physicians feel about patients' efforts to be engaged in shared decision making (SDM). STUDY SETTING AND DESIGN: Survey of physicians from distinctly different medical disciplines (238 psychiatrists and 169 vascular surgeons). Participants were requested to judge which patient behaviours they find helpful and which behaviours detrimental for SDM.

Why do some patients with schizophrenia want to be engaged in medical decision making and others do not?

Objective: Treatment guidelines for schizophrenia recommend that medical decisions should be shared between patients with schizophrenia and their physicians. Our goal was to determine why some patients want to participate in medical decision making and others do not.

Method: To identify determinants of participation preferences in schizophrenia patients (ICD-10 criteria) and in a nonpsychiatric comparison group (multiple sclerosis), we undertook a cross-sectional survey in 4 psychiatric and neurologic hospitals in Germany.

Do physicians' recommendations pull patients away from their preferred treatment options?

Context And Objective: Shared decision making is especially advocated for preference-sensitive decisions. We investigated whether physicians' recommendations pull patients away from their preferred treatment option when making a preference-sensitive decision. DESIGN, PARTICIPANTS AND METHODS: Inpatients (N = 102 with schizophrenia, N = 101 with multiple sclerosis) were presented with a hypothetical scenario (the choice between two drugs).

'What would you do if you were me, doctor?': randomised trial of psychiatrists' personal v. professional perspectives on treatment recommendations.

Background: If patients are unsure whether a specific treatment is really good for them, they often pose the question, 'What would you do if you were me, doctor?' Patients want their psychiatrists to put themselves in their shoes and not to give a 'standard recommendation'.

Aims: To study whether this question really leads psychiatrists to reveal their personal preferences.

Method: Randomised experimental study with 515 psychiatrists incorporating two decision scenarios (depression scenario: antidepressant v.

Can psychiatrists and neurologists predict their patients' participation preferences?

There is evidence that an optimal match of patients' participation preferences improves health outcomes. Since it is unknown whether psychiatrists and neurologists can predict their patients' participation preferences we performed a cross-sectional survey involving N = 101 inpatients with schizophrenia/schizoaffective disorder and N = 102 inpatients with multiple sclerosis. Both patients and their physicians in charge were surveyed with respect to the patients' participation preferences, using the Autonomy Preference Index and a global estimate.

How much more effective do depot antipsychotics have to be compared to oral antipsychotics before they are prescribed?

Antipsychotic depots are less frequently prescribed than oral compounds. In an experimental study involving N=106 psychiatrists we studied how much more effective with respect to relapse prevention depot antipsychotics have to be compared to oral antipsychotics before they are chosen for prescription. Most psychiatrists have to judge depot as clearly superior with respect to relapse prevention before they recommend it to patients.

Psychiatrists' use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics.

Objective: Shared decision making is advocated as a way of involving patients in medical decisions, but it can be achieved only when both patients and physicians commit to sharing decisions. This study explored psychiatrists' views of shared decision making in schizophrenia treatment.

Method: A structured questionnaire was given to 352 psychiatrists at the 2007 congress of the German Society of Psychiatry, Psychotherapy, and Nervous Diseases to determine their self-reported decision-making styles.

Identifying the profile of optimal candidates for antipsychotic depot therapy A cluster analysis.

Objective: The prescription rate of antipsychotic depots for patients suffering from schizophrenia is currently low. Among these patients the assumable acceptance rate of depot as treatment of choice is markedly higher, but psychiatrists do report that patients frequently reject the offer of depot treatment. In a first step to highlight this contradiction we aimed at identifying attributes of patients that indicate their qualification for depot treatment in the eyes of the psychiatrists.

Patients' and psychiatrists' perceptions of clinical decisions during schizophrenia treatment.

Shared decision making is advocated for patients with schizophrenia. However, there is limited knowledge as to which events are actually considered to be decisions by psychiatrists and patients. Semistructured interviews with regard to clinical decisions of the preceding week were performed with psychiatrists and inpatients with schizophrenia.

[Complaint-management in psychiatry - a nationwide survey in Germany].

Objective: To describe and characterize the work of independent complaint offices for users of psychiatric services and of ombudsmen in psychiatric hospitals.

Methods: Nationwide survey addressed to all independent complaint offices and to all psychiatric hospitals in Germany.

Results: The authors were able to identify n = 37 independent complaint offices.