Enhancing treatment decision-making in bipolar II disorder: Development and evaluation of a treatment decision-aid for patients and their families

Abstract

Background/Aims. A diagnosis of bipolar II disorder (BPII) is commonly accompanied by a need to make complex treatment decisions. As most research on treatment efficacy relates to bipolar I disorder, BPII treatment decisions have less evidence to support available treatment options and are more finely balanced in terms of benefits and side-effects. Yet, there is currently no resource to support patients with BPII (and their families) to make informed, preference-based treatment decisions. Patient decision-aids (DAs) are interventions designed to facilitate this process. This thesis aimed to develop and evaluate the first known DA for patients considering BPII treatment options. Methods. The thesis comprised four phases: i) a systematic literature review (Chapter 2); ii) qualitative interviews with patients with BPII (n=28), their families (n=13), and clinicians (n=20) (Chapters 3 – 5); iii) development of a DA according to International Patient Decision-Aid Standards (Chapter 6); iv) pilot of the DA to obtain evidence on its acceptability, feasibility, safety, and potential usefulness within a sample of potential end-users (30 patients with BPII, and 10 families; Chapter 7). Results. Phases i) and ii) identified key informational and decision-support priorities for patients with BPII and their families, as well as clinician-endorsed strategies for addressing barriers to treatment decision-making. These priorities and strategies then informed the content, format and delivery of the DA. Pilot data indicated that potential end-users strongly endorsed the DA, and provided preliminary evidence to support DA-related improvements in treatment decision-making. Conclusion. This innovative and comprehensive program of research culminated in the development and evaluation of a world-first DA for patients deciding on BPII treatment. The final DA has the potential to facilitate informed treatment decisions, which are both evidence-based and consistent with patient preferences.