The Missing Person in Personalized Medicine

The effectiveness of personalized medicine hinges on staying true to its name: including the person in the process. Each patient needs specific tools to address their unique disease characteristics. Treatment planning processes are an excellent way to achieve personalized medicine, as they are an evidence-based method of developing individualized treatment plans. Unfortunately, treatment planning processes often exclude the patient, leaving the provider as the sole decision maker. This can be especially unfavorable for individuals with mental illnesses because of the wider range of symptoms, co-occurring illnesses, and the multi-disciplinary team involved in treatment for this population. For example, if a psychiatric healthcare team prescribes therapy sessions, but does not consult the patient regarding their schedule or access to transportation (essentially excluding the patient from the process), a treatment plan will be ineffective. 

A recent study found that although mental health providers understand the evidence-base for and the importance of personalized treatment planning processes, the actual treatment plan is rarely implemented, nor is it patient-centered. The barriers to successful implementation of treatment plans were system-wide regulations, time constraints, and provider education on effective treatment plan implementation. While system-wide regulations are an important foundation for mandating evidence-based practices, it is clear that these regulations, and in some cases, lack thereof, contribute to the gap between developing and implementing mental health treatment plans. Additionally, these regulations seldom leave room for patient self-advocacy, which is essential, as providers being the sole-decision makers does not always translate to successful outcomes for the patient. 

Every treatment planning process should empower the patient in the decision-making process. However, it is rare for a treatment planning policy or regulation to explicitly outline the precise role that the patient plays in their own treatment. For example, a Medicare regulation for medical records requires psychiatric hospitals to include a comprehensive treatment plan that details the “patient’s strength and disabilities”. It is not clear how this is being implemented, nor is it clear what the active role is for the patient or their caregiver. However, state legislatures should build upon Medicare’s lead by creating a standardized, evidence-based, person-centered psychiatric treatment policy. This would not only aid in successful integration of multiple disciplines of mental healthcare providers and self-advocacy tools for consumers, but would also help to incorporate an active role for the patient and/or their caretaker.

This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Satcher Health Leadership Institute. It is written by Margaret Akinhanmi, PhD. She is a Health Policy Leadership Fellow.

Abstract

Treatment planning processes are a fundamental component of evidence-based practice in mental health for people with serious mental illness (SMI), who often present with complex concerns and require an interdisciplinary treatment team. It is unclear how well treatment planning practices in usual care settings for SMI adhere to best practices guidelines. In this study, we used qualitative methods to increase understanding of typical treatment planning practices. Twelve mental health providers completed a participatory dialogue focused on discussing perceptions of ideal and real treatment planning processes. Content analysis of the transcription from the dialogue was used to identify major themes and subthemes. Analysis revealed 6 primary themes with 23 subthemes. Providers described the ideal treatment planning process as dynamic and collaborative, including thorough assessment and inclusion of all stakeholders including the consumer, providers, and family members. Real treatment planning was described as directed by institutional and regulatory needs, resulting in treatment plans that were not personalized and not communicated to frontline staff or the consumer. These results indicate that providers have a strong understanding of evidence-based principles of treatment decision-making. However, actual treatment planning processes rarely live up to those principles. Providers identified several obstacles to enacting best practices. Although many obstacles were system-level, providers themselves also contributed to the gap between ideal and real treatment planning. Additional training and education may help to close this gap. Consumer self-advocacy is also important, given that providers often see themselves as lacking agency to make changes. PMID: 31120294

Treichler, EBH, et al. Psychol Serv. 2019 May 23; epub doi: 10.1037/ser0000361