Researchers at the University of California-Davis and the University of Rochester are leading work on a computerized suicide prevention tool designed to add depth and context to patient engagement technologies.
The researchers have received a $1.3 million, four-year grant from the Centers for Disease Control and Prevention to study the effectiveness of the approach in those most likely to attempt suicide – middle-aged men.
"You don't see commercials on TV telling patients to really think carefully about what it is that's bothering you and making you unwell – whether it's domestic violence you're exposed to, or the garbage in your street, or the fact you just lost your job," said Paul Duberstein, professor of psychiatry and family medicine at the University of Rochester Medical Center. "There are no commercials out there imploring people to talk with their doctors about that."
The CDC funding will be used by Duberstein, co-principal investigator Anthony Jerant, M.D., who works at UC-Davis, and their colleagues to develop and test a multimedia, interactive computer program that allows information to be tailored to the attitudes of users, ideally encouraging them to discuss suicidal thoughts with physicians and accept treatment. Study participants will have access to the program in their doctors’ office waiting areas.
The content and its length will be automatically tailored based on responses to a series of questions about knowledge, beliefs, and attitudes about suicide and their comfort in discussing it with healthcare providers. For example, users who indicate that they believe their doctors cannot help with suicidal thoughts will be informed that all primary care doctors are trained to discuss suicide and ensure appropriate treatment in collaboration with mental health specialists.
Duberstein sad the work is an outgrowth of similar work they did on an interactive multimedia computer program (IMCP) designed to increase discussion and treatment for depression, which also increased physician-patient conversations about suicide even though there was only minimal content dealing with it in the program.
In fact, the team's newest study draws on a predecessor that also informed the IMCP-enabled depression research, that turns the prevailing dynamic of patient communication on its ear: in the initial study, designed by co-investigator Richard Kravitz, M.D., also at UC-Davis, actors separated into three cohorts were instructed to ask physicians for a specific anti-depressant, any anti-depressant, or nothing at all. The intent of the study, Duberstein said, is to gauge the effect of direct-to-consumer advertising on patient and physician behavior.
"The sobering finding there was that doctors prescribed antidepressants to patients in whom it was not clinically indicated if they made a specific request for the antidepressant," Duberstein said. This latest study, he said, is intended to capitalize on the findings of the previous two – to help patients feel confident in communicating their true needs to their physician rather than think the doctor will better understand a D-T-C-derived "ask your doctor" encounter. Such frank communication optimally would lead to clinicians resisting the path of least resistance, which Duberstein said may or may not be the most clinically appropriate decision.
"We need to try to do something, not only about the power asymmetries that exist in the healthcare encounter, but we also need to make sure that patients aren't influenced merely by what they are seeing on the Internet and on TV – that they are inspired to think about what they really need themselves," he said.
Well-designed communications platforms such as those the team will be studying could change that, simultaneously giving patients more confidence to speak more frankly and in depth while giving primary care physicians, who have to be all things to all people to some extent, better tools with which to truly engage the patient, Duberstein said.
"The fact is that most people who die by suicide in this country are not seen by psychiatrists or psychologists, they are in fact seen by primary care doctors," he said. "So, it's very important to try to figure out how to help primary care physicians intervene in the suicidal process.” And, Duberstein added: "These electronic innovations that patients can use in the privacy of their own homes before they see the doctor could really help both change the conversation in the consulting room with the doctor, and also change the landscape of healthcare."
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