A new study suggests that doctors and patients don’t always see eye to eye on depression treatment, and that disconnect may be getting in the way of providing the best possible mental health care.

Earlier this January, a team of researchers in BMJ Open reported the results from a survey of more than a thousand patients and clinicians on what they deemed to be the most important questions to ask when attempting to find a good treatment for depression. Patients were also asked to evaluate how much shared decision-making (SDM) with their doctors went into their depression care. Although both groups agreed that asking about the effectiveness of a proposed treatment was crucial, patients were much more likely to emphasize needing to know about a treatment’s cost and whether it was covered by insurance than doctors. Similarly, only 18 percent of patients reported a high degree of shared decision-making with their doctors, a percentage much lower than with other medical conditions.

“While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns,” the authors concluded. “This mismatch, coupled with low SDM, adversely affects the quality of depression care.”

The groups were polled separately online in late 2014, with the researchers ultimately ending up with 972 consumers and 244 clinicians who fully completed the survey. The consumers were either currently receiving depression treatment or had done so in the past, while the clinicians had counselled, diagnosed or treated a person with depression in the past year. Each group was asked to determine and rank the most important aspects of depression care. The clinicians were additionally asked to imagine what they thought their patients would prioritize most. Though the consumer group wasn’t a true representative sample of depression patients, the researchers did attempt to match the broad demographic trends of lifetime sufferers in their recruitment quotas.

In terms of importance, both groups ranked effectiveness and the likelihood of adverse side effects like suicide similarly. And when clinicians were asked to place themselves in their clients’ shoes, they ranked treatment cost and insurance status much like how patients did. That likemindedness disappeared, however, once the clinicians were asked about their own opinions.

"What we found is although many health care providers realize that their patients want to know how much a particular treatment costs and if insurance will cover it, they don't seem to cover these topics with their patients," said lead author Professor Paul Barr in a statement. Barr is an associate professor at Dartmouth College’s Institute for Health Policy & Clinical Practice in New Hampshire.

This mismatch likely isn’t because of any coldheartedness on clinicians’ part, Barr and his team explained, but rather because they have limited time to meet with patients, have difficulty determining what treatments a patient can specifically afford, and largely believe treatment decisions should be based on whether a patient needs it rather than whether they can afford it.

Making the time and space to address patients’ financial concerns, however, will only improve communication and cooperation, Barr noted, since “the cost of treatment has a significant impact on a patient's financial stability, which can impact their well-being and whether they actually begin a treatment, especially if they cannot afford it."

Improved shared decision-making would also improve the chances of successful treatment, since research has shown that depression patients are more likely to succeed when they are given treatments they prefer, regardless of whether it’s medication or talk therapy. The 18 percent rate of high SDM found in the current study is a far cry from the rates found in treating other medical conditions, which center around 70 percent according to the authors.

"There is a lot that could be done to help patients and health care providers communicate more effectively and to ultimately help people with depression get the treatment they want," Barr said. To that end, Barr and his colleagues are hoping to design customized decision support intervention tools (DESIs) that will help patients understand their treatment options more easily and better facilitate patient-provider communication.

Source: Barr P, Forcino R, Mishra M, et al.Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression. BMJ Open. 2015.