Exploring the Mediating Role of Decisional Conflict in the Relationship Between Shared Decision Making, the Use of Routine Outcome Monitoring, Treatment Outcomes and Patient Satisfaction: An Observational Longitudinal Study in Dutch Mental Health Care

In Shared Decision Making (SDM) patients and clinicians make joint decisions about treatment. The use of Routine Outcome Monitoring (ROM) as a personalized source of information can be helpful when making decisions together. Research suggests this approach has beneficial effects on treatment outcomes and satisfaction. The study aims to investigate if the factors associated with the SDM process contribute to treatment outcomes and satisfaction and whether these outcomes are mediated by Decisional Conflict. An observational longitudinal study was performed using data from a heterogeneous group of patients treated by three Dutch mental health care organizations; 58 patients completed the first and second measurement. First, regression analyses were conducted to examine the relationship between the application of SDM and use of ROM feedback at the start of treatment and outcome factors Symptom Change, Symptom Severity (measured by Symptom Questionaire-48, Brief Symptom Inventory, 36-Item Short Form Health) and Patient Satisfaction (rating on a scale from 0 to 10) 3 to 6 months later. Second, we conducted mediation analyses to investigate whether Decisional Conflict serves as a possible mediating factor through which the SDM process and the use of ROM feedback influences the outcome variables. Results showed that the use of ROM feedback had a significant effect on Symptom Change, however was not mediated by Decisional Conflict. SDM process variables (Feeling Informed, Clarity and Support) were significantly associated with Symptom Severity. Only the effect of Feeling Informed on Symptom Severity was mediated by Decisional Conflict. Support also accounted for a significant part of the variance in Patient Satisfaction, but there was no mediation effect of Decisional Conflict. The SDM process and the use of ROM feedback appears to play a more important role in improving outcomes than Decisional Conflict. These findings also seem to indicate the importance of the patient-clinician working alliance, because this working alliance influences the SDM process and conversely a good SDM process improves the working alliance. This aligns with the evidence from earlier research. We recommend to continue this research on the impact of decisional conflict using a larger sample over a longer period of time.