Antipsychotic choice: understanding shared decision-making among doctors and patients

Background: In deciding pharmacotherapy treatment, doctors have to balance the risks and benefits of treatment, and their preferences may not always align with patient preferences. Aim: A pilot study to explore decision-making regarding treatment with antipsychotic medications among doctors and patients. Methods: A discrete choice experiment (DCE), comprised of systematically structured choice tasks, in which doctors and patients were asked to trade off between attributes of antipsychotic medications, each described in terms of mode of administration, effectiveness (on positive and negative symptoms) and side effect profiles. Participants also ranked different factors that they consider important when choosing an antipsychotic medication. Results: 52 doctors and 49 patients completed the survey. Doctors accepted a higher risk of side effects than patients if it achieved better efficacy. Patients perceived long-acting injectables (LAIs) to be easier than taking tablets every day. Issues of embarrassment, pain and fear of needles were not rated as highly by patients, as anticipated by doctors. Conclusions: Doctors and patients demonstrated differences in decision-making about treatment with antipsychotic medications. Addressing these issues could facilitate shared decision-making, with the goal of improving patient adherence to antipsychotic medications, and thereby improve patient outcomes.This study was funded via a grant from the St. Vincent’s Hospital Research Endowment Fund. In addition, Dr D. C., Dr V. Y., Dr M. D, Dr V. A. were supported by investigator-initiated grants from Lundbeck, Servier and Otsuka. Dr M. D. is supported by a National Health and Medical Research Council Career Development Fellowship (APP1122526)