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Identification and Rating of Treatment Goals in Schizophrenia: Delphi Process and Concordance Survey in Matched Physician-Patient Pairs

Year: 2025
Type: article
Abstract: Gerhard Gründer,1 Philipp Bauknecht,2 Stefanie Schell,3 Karolina Leopold,4,5 Michael Paulzen,6– 8 Stefan Leucht9,10 1Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; 2Dr. Carl GmbH, Stuttgart, Germany; 3Klinikum Blankenburg, Harzklinikum Dorothea Christiane Erxleben, Akademisches Lehrkrankenhaus der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany; 4Department of Psychiatry and Psychotherapy, Vivantes Klinikum Am Urban, Berlin, Germany; 5Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany; 6Alexianer Center for Mental Health, Aachen, Germany; 7Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; 8JARA - Translational Brain Medicine, RWTH Aachen University, Aachen, Germany; 9Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technische Universität München, Munich, Germany; 10German Center for Mental Health, Partner Site Munich/Augsburg, Munich, GermanyCorrespondence: Gerhard Gründer, Abteilung Molekulares Neuroimaging, Zentralinstitut für Seelische Gesundheit (ZI), J 5, Mannheim, 68159, Germany, Tel +49 621 1703 1900, Fax +49 621 1703 80 1900, Email [email protected]: Ratings of treatment goals for patients with schizophrenia have been studied in both patients and physicians. However, in most studies so far, treatment goals were assessed either by psychiatrists or by patients, but not by both for an individual patient case. Therefore, our study assessed treatment goals from matched physician-patient pairs.Methods: First, an expert panel created a questionnaire with treatment goals, based on a systematic literature search. These goals were rated for their relevance in the treatment of schizophrenia by 24 independent psychiatrists. In the second part of the study, questionnaires were sent to psychiatrists all over Germany. Psychiatrists were asked to rate treatment goals for up to 3 specific patients. Furthermore, these same patients were asked to rate the goals for themselves.Results: In the first part of the study, the 24 psychiatrists agreed that 30 out of 31 treatment goals chosen by the expert panel were relevant. In the second part, effectiveness and quality of life were more often seen as the most important treatment goal categories than tolerability by both patients and physicians in matched pairs of 80 patients and 28 physicians. There was a substantial agreement between physicians and patients. However, patients expressed apprehension about possible side effects of the medication, a concern not recognized in its extent by physicians. Patients also prioritized treatment goals related to tasks of daily life and coping with illness, whereas physicians put greater emphasis on preventing relapses and re-hospitalizations.Conclusion: We found that experts agree upon the importance of 30 treatment goals from three categories. Physicians and patients largely align on treatment goals. More emphasis may be placed on clarifying potential medication side effects. Physicians should be aware that patients’ priorities could be more focused on improving quality of life and gaining autonomy rather than symptom management.Keywords: Schizophrenia, treatment goal, patient centered, concordance
Authors: Gründer G, Bauknecht P, Schell S, Leopold K, Paulzen M, Leucht S
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W7057077341
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