A Mobile App Designed to Promote Shared Decision-Making in the Treatment of Psychotic Disorders: Feasibility and Acceptability Study.

Abstract

Background: Strengthening shared decision-making in mental health care may improve the quality of services and treatment outcomes, but its implementation in services for severe mental disorders is currently lacking.

Objective: This study aims to explore the feasibility and acceptability of iTandem (University of Oslo), a mobile app designed to promote shared decision-making in the treatment of psychotic disorders. In addition, the study aims to investigate mechanisms that potentially contribute to the intended effect of the app. iTandem is a therapy supplement that facilitates patient involvement in decisions regarding treatment goals and focus areas. It is designed for personalized use and contains 8 optional modules: sleep, medication, recovery, mood, psychosis, activity, substance use, and feedback concerning therapy.

Methods: Patients undergoing assessment or treatment for psychotic disorders and their clinicians were recruited for the study. Patients and clinicians jointly used iTandem as part of standard treatment in a 6-week trial. We used a mixed-methods study design with a clear emphasis on qualitative methods. Feasibility and acceptability were assessed through descriptive statistics based on preintervention and postintervention questionnaires and app usage data, in addition to text responses to open-ended items. We conducted a reflexive thematic analysis of postintervention interviews to elaborate these measures and to explore mechanisms potentially contributing to achieving shared decision-making when using iTandem.

Results: A total of 9 patients and 8 clinicians completed the trial. The participants evaluated iTandem as a user-friendly and acceptable tool, but there were considerable variations in how the app was integrated into treatment and in perceptions of its clinical value. The thematic analysis suggests that iTandem has the potential to facilitate shared decision-making through supporting cognition and shifting the patient's role. We also identified scaffolding structures, an analogy of personalized support, as a precondition for these mechanisms and for the overall feasibility and acceptability of iTandem.

Conclusions: iTandem was generally perceived as a feasible and acceptable tool in the treatment of patients with psychotic disorders. Our findings suggest that nonclinical aspects, such as support structures, are important to the feasibility and acceptability of such digital interventions and patients' aptness for digitalized treatment in general. Future research should explore related nonclinical aspects further instead of defining potential target groups based on diagnoses and symptom severity alone.