M.D.s, Patients Need Help With Communication Skills
Though psychiatrists taking part in a recent study demonstrated that they were knowledgable about using medication to prevent relapse in schizophrenia patients, they often failed do a good job of communicating those treatment plans to patients.
In addition, the psychiatrists only offered psychoeducation, which has been shown to increase medication compliance, to about one-third of their patients.
The findings come from a survey of 50 psychiatrists working with 100 patients in Germany in 2002 and appeared in the November Psychiatric Services.
To recruit a sample of psychiatrists and patients, primary investigator Johannes Hamann, M.D., presented information about the study at morning rounds in eight psychiatric hospitals in southern Germany.
Hamann is a psychiatry resident at the Technischen Universität Munchen in Munich.
He recruited 50 psychiatrists who were treating inpatients with schizophrenia and surveyed each about two patients who were about to be discharged from inpatient care.
When psychiatrists were asked about how long they thought each patient should receive relapse-prevention therapy with antipsychotic medications, for 75 percent of the patients they cited time frames that agreed with the German Psychiatric Association's Guidelines for the Treatment of Schizophrenia.
The German guidelines for treating schizophrenia are similar to those of APA and specify that patients experiencing their first episode of schizophrenia should receive one to two years of relapse-prevention treatment. According to the guidelines, those with previous episodes require at least four years of relapse-prevention treatment.
Hamann found that for 26 of the 100 patients, psychiatrists did not discuss relapse prevention or maintenance therapy before discharge, and in 26 additional cases they had not discussed a clear time frame for continuing with treatment. “Psychiatrists gave correct recommendations for relapse prevention for only 33 of 100 patients and recommended time frames that were too short for the remaining 15 patients,” according to the report.
There was also a discrepancy between what psychiatrists said they told patients and what the patients said psychiatrists told them about treatment. Of the 92 patients who agreed to be interviewed, 71 reported that their physicians had neither discussed maintenance therapy with them nor mentioned a specific time frame for continuing treatment (physicians said they did not discuss continuing treatment or give clear time frames for treatment for 52 patients).
In addition, the physicians in the study stated that for 78 patients, they had taken some measure to improve medication compliance, yet offered psychoeducation to only 30 patients.
Psychoeducation was defined as a “structured intervention” used by physicians in a group or individual sessions with patients involving a manual or specific literature. Informal talks with patients and families did not count.
“There is, to my knowledge, no evidence that chronic patients do not profit from psychoeducation,” Hamann told Psychiatric News.
Most of the patients who received psychoeducation were younger or had a shorter duration of illness, the study found.
Hamann speculated that “doctors distinguish between patients for whom they believe psychoeducation to be reasonable,” such as younger patients. “Probably the older or more chronic patients are seen as `hopeless cases' for whom psychoeducation may not change anything,” he said.
Nor could Hamann account for the fact that physicians in the study only offered depot injections to a minority of patients (16) and contacted the physician who would be treating the patient after hospital discharge in only 24 cases.
“Neglecting to communicate with patients for whatever reason seems especially inappropriate in view of results from studies on physician-patient communication that show effective communication. .improves health outcomes,” Hamann and collegues wrote.
Hamann said that doctor-patient communication can be improved through shared decision making regarding schizophrenia treatment.
More specifically, physicians should offer patients information about a number of treatment options, and both physicians and patients could benefit from communication skills training.
Communication skills training for patients should take into account“ illness-specific” problems such as thought disturbance, he said. Such training may also seek to improve patients' social skills.
“Physicians' and Patients' Involvement in Relapse Prevention With Antipsychotics in Schizophrenia” is posted at<ps.psychiatryonline.org> under the November 2005 issue.▪
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Published online: 16 December 2005
Published in print: December 16, 2005
Notes
Physicians need to be more explicit when they communicate with patients about treatment plans, according to results from a European survey of psychiatrists and their schizophrenia patients.
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