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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
patient preferences in mental health units
- Ambreen Aslam (4 November 2008)
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"randomised evidence is considered most rigorous"
- Julian C. Law (11 January 2009)
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Patient preference and mental capacity
- Anita Damle (12 January 2009)
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Ambreen Aslam, staff grade wickham unit , Blackberry hill hospital Bristol ,BS161WS
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It is generally felt that patient preferences for treatments offered in mental health services have both positives and negatives associated with it.Some of the very experienced patients are exactly able to inform the psychiatrists as to what antipsychotics have helped them in the past. And this really works for a better outcome. But then there are patients with poor insight into their illness and they might want to stop the only antipsychotic which has beneficial effects on their mental health. I feel it is a bit tricky with mental health patients but still giving priority to their preferences in treatment builds up a good therapeutic relationship and patients feel contributing themselves towards their road to recovery. Competing interests: None declared |
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Julian C. Law, GP, Kirkby-in-Ashfield NG177AE
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It is fascinating how the placebo effect and the idea of patient preference questions the dominance of the randomised clinical trial and the evidence-based practice of medicine. Not everything is measurable and the complexity of human beings and systems means that we can not quantify every observation. Human preferences are perfectly valid although difficult to measure and place in the context of quantitative medical research. It is important that the reflective practising clinician is aware that there is more at work than statistical significance. Competing interests: None declared |
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Anita Damle, Consultant Psychiatrist St. Andrews Healthacre,NN1 5DG
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Klim Mcpherson’s editorial raises an important issue in the climate of evidence based therapeutics. However, the statement that “Where treatment choices have different and well understood outcomes, what matters most when deciding which treatment is best is the patient’s preference”, I presume he refers to patients who have capacity. Even in patients who have capacity, their preferences may be based on misinterpretation or perceived benefit of less effective drug or treatment. (e.g. hypomanic patients may prefer to continue with less effective drugs so as to remain in an aroused “grandiose and elated” state or psychotic patient may have delusional explanation for his preference). In addition if the effect is measured by self rating scales then this can have well known limitation of bias and the effect may not be real. The patient preferences are important in many of the psychological therapies but again patient’s preferences are not always in the best interest as far as the effectiveness of treatments for that patient is concerned e.g. a severely psychotically depressed patient may prefer CBT to antidepressant but antidepressants are known to be more effective. As to the positive effect of patient preference, this is clearly used in psychological treatments and does play an important role in engaging and actively participating in therapy and therefore its outcome. In mental health field therefore the patient preferences need to be balanced with the right of patients to be treated with the most effective treatment and randomised evidence should be considered best at least in treating severe mental illness despite the “preference effect elephant” in the room. Competing interests: None declared |
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