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

Introduction: 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.