Study Shows Majority of Veterans with Serious Mental Illness Prefer Family Involvement in their Care
Matching treatment to patient preferences improves the use of and adherence to appropriate treatment, patient satisfaction, and outcomes. Efficient and standardized approaches are needed to help individuals diagnosed with serious mental illness identify and express their preferences for family involvement in care. The Recovery Oriented Decisions for Relative's Support (REORDER) intervention is an innovative, manualized protocol that uses a shared decision-making process to facilitate a patient's consideration of family involvement in care. REORDER has two phases: during Phase 1, patients meet with REORDER clinicians to discuss preferences for family involvement, focusing on how the family can help meet recovery goals; Phase 2, if desired, provides family support, education, and strategies to participate in promoting the patient's recovery goals. This article reports on baseline data from a multi-site, randomized controlled trial of the REORDER intervention. Investigators analyzed interview data for 232 Veterans diagnosed with serious mental illness (e.g., schizophrenia, bipolar disorder) who had at least two VA outpatient mental health visits — and contact with a family member or caregiver in the previous six months. In-person interviews were conducted between 10/07 and 11/10. Investigators examined demographics, clinical characteristics, preferences for family involvement (e.g., family receives written information, family attends support group), as well as anticipated benefits and barriers of family involvement in mental healthcare.
- The majority (78%) of Veterans in this study wanted their family involved in their care; many desired family to be involved via several methods.
- Veterans were concerned about the impact family involvement would have on themselves and their family. This desire to minimize the impact of their illness on family members has rarely been noted in the literature, but is important for providers to understand.
- Veterans also expressed concerns about the negative effects of involvement, including a loss of personal privacy and decreased time for the involved family member to attend to other responsibilities.
- The degree to which a Veteran expected benefits from family involvement in care predicted the degree of desired family involvement, whereas anticipating barriers did not. While each individual differs, these findings suggest the importance of helping Veterans to identify benefits.
- The authors recommend that a variety of family involvement options be offered for consideration by Veterans with serious mental illness, and that VA facilities engage Veterans in a shared decision-making process, such as REORDER. Such a personalized program has the ability to produce better-informed decisions based on thoughtful consideration of needs and preferences that can lead to enhanced utilization of family services.
This study was funded by HSR&D (IIR 04-255). Dr. Cohen is part of HSR&D's Center for the Study of Healthcare Provider Behavior, Sepulveda, CA, and VA's Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC).
Cohen A, Drapalski A, Glynn S, Medoff, D, Fang, L, and Dixon, L. Preferences for Family Involvement in Care by Consumers with Serious Mental Illness. Psychiatric Services December 15, 2012;e-pub ahead of print.