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Treatment choice in psychiatry? Would trainees choose similar treatments to those prescribed, and what influences decision-making? A survey of the European Federation of Trainees' (EFPT) Research Group

Published online by Cambridge University Press:  24 June 2014

Sameer Jauhar,
S. Gerber,
O. Andlauer,
J. G. Marques,
L. Mendonca,
I. Dumitrescu,
C. Roventa,
G. Lydall,
S. Guloksuz and
E. Dobrzynska
...Show all authors
Sameer Jauhar
Affiliation:
General Adult Psychiatry, Gartnavel Royal Hospital, Glasgow
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Abstract

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Keywords

Surveyraineesdecision-makingefficacyantipsychoticsantidepressantsmood stabilisers

Information

Type
Inpc Young Psychiatrists Programme
Information
Acta Neuropsychiatrica , Volume 21 , Issue S2: Special Issue: Abstracts of 49th Neuropsychiatric Pula Congress, 17-20 June 2009, Pula, Croatia , June 2009, pp. 64 - 65
Copyright
Copyright © 2009 John Wiley & Sons A/S

Introduction:

Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics Reference Jones, Barnes, Davies, Dunn, Lloyd and Hayhurst(1-Reference Leucht, Corves, Arbter, Engel, Li and Davis4). Our Pan-European Research Group asked Psychiatry trainees for their own treatment preferences and factors influencing decision-making. We questioned if trainees' own choices differed to those for patients, what their actual choices were, and what factors influenced decision-making.

Material and methods:

A semi-structured survey was constructed from prior literature Reference Steinert(5-Reference Taylor and Brown7), piloted, and a homogenous sample size of 50 was agreed upon from each country, with 50% minimum response rate. It was distributed in English, via web-link, with questions on guidelines, preference of antipsychotic/mood stabiliser/antidepressant for patients in given scenarios, and factors influencing choice. Physicians were asked for their own preference.

Results:

As the survey is ongoing, data are preliminary, that pertaining to antipsychotics presented below.

i) Treatment choice of antipsychotic

95% (n = 208) chose to receive “atypical” antipsychotics (excluding Clozapine), 5% (n=10) choosing “typical” antipsychotics, one choosing Clozapine as first-line therapy.

ii) Factors influencing choice

These mapped onto three domains: efficacy, side-effect profile and cost (less than 5% other reasons). Strikingly, for antipsychotics, 81% (n= 177) felt efficacy most important, 48% (n= 105) felt side-effect profile most important and 3% (n= 7) considered cost of paramount importance.

Discussion:

Though data are preliminary, it appears Psychiatry trainees would choose to receive some treatments based on perceived benefits, as opposed to evidence base and recent literature. It will be interesting to analyse factors influencing decision-making in clinical practice.

Word count 240 words

Acknowledgements:

We would like to thank all those who contributed to the survey and Drs Malik and Rojnic (EFPT President and President-Elect) for their continued support and guidance.

References

References:

1.Jones, PB, Barnes, TRE, Davies, L, Dunn, G, Lloyd, H, Hayhurst, KP, et al.Randomized Controlled Trial of the Effect on Quality of Life of Second- vs. First-Generation Antipsychotic Drugs in Schizophrenia: Cost Utility of the Latest Antipsy-chotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 2006;63(10):1079–1087.CrossRefGoogle Scholar
2.Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, et al.Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. N Engl J Med 2005;353(12):1209–1223.CrossRefGoogle ScholarPubMed
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