Background

In Community Mental Health Teams (CMHTs), patients and their care coordinators meet regularly but the communication in their meetings is not typically guided by research evidence. ‘DIALOG’ was the first method to structure this communication.

A technology-supported intervention, DIALOG is delivered on a hand-held computer that is shared between patients and care coordinators. The clinician invites the patient to rate their satisfaction with 11 important topics and explores needs for more help in each area using the tool. These topics are mental health, physical health, job situation, accommodation, leisure activities, relationship with partner/family, friendships, personal safety, medication, practical help and meetings.

An international study found that regular use of the tool improved quality of life and treatment satisfaction in patients diagnosed with schizophrenia, as well reducing their unmet needs.

Following this study, the ‘EPOS’ programme was funded to further develop DIALOG locally, in the U.K.

Research questions

• How can the technology supporting DIALOG be improved to optimise its implementation in the NHS?
• How can the intervention be expanded to further improve patient-clinician communication?
• How effective is the resulting new intervention – ‘DIALOG+’ – in improving patient outcomes?

Research activities

• We identified the iPad tablet as suitable technology to support the intervention, as it can be easily shared between the patient and the clinician, and employs a touch-screen, amongst other advantages. We conducted focus groups with patients to develop ideas on how to design the new DIALOG app for iPad.
• We extended the intervention so that clinicians help patients to identify solutions to issues flagged through DIALOG. We developed a manual informed by Solution Focused Therapy to guide clinicians in their approach to problem-solving with patients. This extended intervention is what we call ‘DIALOG+’.
• We trialled the new DIALOG+ intervention with patients with schizophrenia and their clinicians in East London mental health teams. We found that DIALOG+ was particularly helpful in reducing patients’ unmet needs. It also improved their satisfaction with life, though slightly less consistently.

Conclusion

• DIALOG+ is as effective as many more extensive forms of psychotherapy, such as Cognitive Behavioural Therapy. It is a useful tool that can be easily implemented in meetings between patients and their care coordinators. iPad users can download the DIALOG app for free from the App Store.

Useful links

www.isrctn.com/ISRCTN34757603

https://itunes.apple.com/us/app/dialog/id914252327?ls=1&mt=8

Staff

• Eoin Golden
• Prof. Stefan Priebe

Funder

• National Institute for Health Research, Programme Grant for Applied Research