PMID- 30288411 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2381-4683 (Electronic) IS - 2381-4683 (Linking) VI - 1 IP - 1 DP - 2016 Jul-Dec TI - How Do Psychiatrists Apply the Minimum Clinically Important Difference to Assess Patient Responses to Treatment? PG - 2381468316678855 LID - 10.1177/2381468316678855 [doi] LID - 2381468316678855 AB - Symptom report scales are used in clinical practice to monitor patient outcomes. Using them permits the definition of a minimum clinically important difference (MCID) beyond which a patient may be judged as having responded to treatment. Despite recommendations that clinicians routinely use MCIDs in clinical practice, statisticians disagree about how MCIDs should be used to evaluate individual patient outcomes and responses to treatment. To address this issue, we asked how clinicians actually use MCIDs to evaluate patient outcomes in response to treatment. Sixty-eight psychiatrists made judgments about whether hypothetical patients had responded to treatment based on their pre- and posttreatment change scores on the widely used Positive and Negative Syndrome Scale. Psychiatrists were provided with the scale's MCID on which to base their judgments. Our secondary objective was to assess whether knowledge of the patient's genotype influenced psychiatrists' responder judgments. Thus, psychiatrists were also informed of whether patients possessed a genotype indicating hyperresponsiveness to treatment. While many psychiatrists appropriately used the MCID, others accepted a far lower posttreatment change as indicative of a response to treatment. When psychiatrists accepted a lower posttreatment change than the MCID, they were less confident in such judgments compared to when a patient's posttreatment change exceeded the scale's MCID. Psychiatrists were also less likely to identify patients as responders to treatment if they possessed a hyperresponsiveness genotype. Clinicians should recognize that when judging patient responses to treatment, they often tolerate lower response thresholds than warranted. At least some conflate their judgments with information, such as the patient's genotype, that is irrelevant to a post hoc response-to-treatment assessment. Consequently, clinicians may be at risk of persisting with treatments that have failed to demonstrate patient benefits. FAU - McMichael, Alan J AU - McMichael AJ AD - Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK (AJM, FAO, FK). AD - Department of Psychology, University of Essex, Essex, UK (JJR). AD - Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina (MB). AD - Gibson Institute, School of Biological Sciences, Queen's University Belfast, Belfast, UK (MB). AD - Institute of Neuroscience, Newcastle University, Campus of Ageing and Vitality, Newcastle Upon Tyne, UK (JPMK). FAU - Rolison, Jonathan J AU - Rolison JJ AD - Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK (AJM, FAO, FK). AD - Department of Psychology, University of Essex, Essex, UK (JJR). AD - Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina (MB). AD - Gibson Institute, School of Biological Sciences, Queen's University Belfast, Belfast, UK (MB). AD - Institute of Neuroscience, Newcastle University, Campus of Ageing and Vitality, Newcastle Upon Tyne, UK (JPMK). FAU - Boeri, Marco AU - Boeri M AD - Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK (AJM, FAO, FK). AD - Department of Psychology, University of Essex, Essex, UK (JJR). AD - Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina (MB). AD - Gibson Institute, School of Biological Sciences, Queen's University Belfast, Belfast, UK (MB). AD - Institute of Neuroscience, Newcastle University, Campus of Ageing and Vitality, Newcastle Upon Tyne, UK (JPMK). FAU - Kane, Joseph P M AU - Kane JPM AD - Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK (AJM, FAO, FK). AD - Department of Psychology, University of Essex, Essex, UK (JJR). AD - Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina (MB). AD - Gibson Institute, School of Biological Sciences, Queen's University Belfast, Belfast, UK (MB). AD - Institute of Neuroscience, Newcastle University, Campus of Ageing and Vitality, Newcastle Upon Tyne, UK (JPMK). FAU - O'Neill, Francis A AU - O'Neill FA AD - Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK (AJM, FAO, FK). AD - Department of Psychology, University of Essex, Essex, UK (JJR). AD - Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina (MB). AD - Gibson Institute, School of Biological Sciences, Queen's University Belfast, Belfast, UK (MB). AD - Institute of Neuroscience, Newcastle University, Campus of Ageing and Vitality, Newcastle Upon Tyne, UK (JPMK). FAU - Kee, Frank AU - Kee F AD - Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK (AJM, FAO, FK). AD - Department of Psychology, University of Essex, Essex, UK (JJR). AD - Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina (MB). AD - Gibson Institute, School of Biological Sciences, Queen's University Belfast, Belfast, UK (MB). AD - Institute of Neuroscience, Newcastle University, Campus of Ageing and Vitality, Newcastle Upon Tyne, UK (JPMK). LA - eng PT - Journal Article DEP - 20161111 PL - United States TA - MDM Policy Pract JT - MDM policy & practice JID - 101707716 PMC - PMC6124922 OTO - NOTNLM OT - clinical practice guidelines OT - managed care OT - patient decision making OT - quality of care EDAT- 2016/11/11 00:00 MHDA- 2016/11/11 00:01 PMCR- 2016/11/11 CRDT- 2018/10/06 06:00 PHST- 2016/01/15 00:00 [received] PHST- 2016/10/11 00:00 [accepted] PHST- 2018/10/06 06:00 [entrez] PHST- 2016/11/11 00:00 [pubmed] PHST- 2016/11/11 00:01 [medline] PHST- 2016/11/11 00:00 [pmc-release] AID - 10.1177_2381468316678855 [pii] AID - 10.1177/2381468316678855 [doi] PST - epublish SO - MDM Policy Pract. 2016 Nov 11;1(1):2381468316678855. doi: 10.1177/2381468316678855. eCollection 2016 Jul-Dec.