Speaker
Gregory Simon, MD, MPH
Senior Investigator
Kaiser Permanente Washington Health Research Institute
Susan M Shortreed, PhD
Senior Investigator, Biostatistics Unit
Kaiser Permanente Washington Health Research Institute
Affiliate Professor, Department of Biostatistics
University of Washington
Keywords
Care Management; Dialectical Behavior Therapy; Patient engagement; Suicide prevention
Key Points
- The SPOT trial was a pragmatic randomized clinical trial comparing care management and dialectical behavioral therapy skills training to usual care in adults at risk of self-harm or suicidal behavior.
- Dialectical Behavior Therapy skills training (DBT) was delivered online and supported by coaching.
- A care management intervention was intended to facilitate and maintain engagement in effective outpatient care.
- Adult outpatients who reported suicidal ideation on a mental health questionnaire were randomized to one of 3 study groups: continued usual care, offer of Care Management program, offer of DBT skills Training program.
- Patients were sent a message expressing care and concern through an online system and invited to participate in the study.
- Patients were followed for 18 months and fatal or non-fatal self-harm events were recorded as the primary outcome measure.
- Interim analysis detected a signal of possible serious outcome in April/May 2019, but upon analysis rerun, the signal dropped below threshold and the DSMB recommended the trial continue.
- Patients offered care management had no reduction in Risk of self-harm behavior compared to usual care. Patients offered DBT had significantly increased risk of self-harm compared to usual care.
Discussion Themes
Real-time feedback from potential subjects is important to ascertain if recruitment efforts or intervention is affecting patients negatively.
The inclusion of the usual care group allowed us to determine more than just care management works better than DBT.
Read more about the SPOT trial and study results.
Tags
#pctGR, @Collaboratory1