Novel Assessment Tools Allow for More Productive Patient-Clinician Time
(Part 2 of 2)
Lisa Brenner PhD, director of the Rocky Mountain Mental Illness Research Education and Clinical Center, Denver, Colorado, explains how 2 novel assessment tools, the Computerized Adaptive Diagnostic (CAD-PTSD) and the Computerized Adaptive Testing (CAT-PTSD), can quickly and accurately diagnose PTSD, allow for more productive patient-clinician time, and may be utilized in the future to diagnose other mental health disorders.
In the previous part 1, Dr Brenner shares how the similarities between post-traumatic stress disorder (PTSD) and other major mood disorders, such as depression, can lead to misdiagnosis.
Read the transcript:
I know that part of the reason I'm here today is to talk again about the tools that Robert Gibbons and his colleagues at Adaptive Technologies have worked on and that we were able to test in the VA.
In specific, we worked on two measures for PTSD. One is the computerized adaptive diagnostic test and the other one is the computer adaptive testing. It's the CAD PTSD and the CAT PTSD. CAD is for diagnostic, that's how I always remind myself which is which.
The CAD lets us think about, is PTSD on the table? Yes or no. The CAT lets us figure out the severity of symptoms associated. Again, as I mentioned before, whether using the CAD or the CAD and CAT together, or you're using something more traditional, like the PCL 5, you always want to make sure that the symptoms are associated with the traumatic stressor.
Now, people are like, "Why do we need new tools, and what's important about this?" One thing that I think is really important is we want to make sure that the time that clinicians and patients have together face to face is incredibly productive.
In my mind, that means letting patients do as much as they can on their own before they get to the session or at the beginning of the session so that the provider has a great starting point and can work with the patient on treatment.
Much like you go into the doctor's office and they take your blood pressure and you might have somebody ask you a couple of questions, and you may even get your lab work done before you go to the doctor, which is amazing because then the doctor has a good starting point.
What I love about the CAD and CAT together is it's a terrific starting point for diagnosing and accurately diagnosing PTSD. The way I think about this is, the quicker we can get to an accurate diagnosis, the more time the patients and providers have during sessions to engage in shared decision making regarding treatment options.
This shared decision making process is where patients and providers work together to look at evidence based interventions and how these evidence based interventions fit with the patient's preferences, the patient's life and lifestyle, and how do they move forward together to address these symptoms.
That conversation takes time because there's different options. There may be mitigating factors, there may be other diagnoses on board that could impact, people have may have life circumstances that get in the way of them maybe being able to be regularly in treatment. The more time that providers and patients can have in these discussions, the better.
One tool I also want to highlight for providers and patients is if you google the VA National Center for PTSD, and specifically the VA National Center for PTSD Treatment Decision Aid, the National Center, which is a great resource for everything PTSD, the Decision Aid is designed to help patients learn about effective PTSD treatment options.
There's information on there for patients, there's videos on there to explain how treatments work, and they can compare and contrast treatments. This is actually a tool that patients and providers, that is a patient driven tool that you can work together on to come up with a personalized summary of what treatments might be best for you or for the patients to engage in action to help relieve symptoms.
It's focused on this idea of learning about the treatments or learn, compare, how do you actually pick which one and then act? Getting engaged in treatment. What I want to let folks know too, providers and patients alike, is we do have effective treatments for PTSD.
The most effective treatments for PTSD are psychotherapy. They can be a little bit hard because some of them are bringing up thoughts and feelings about traumatic events, but they work.
The more that we can find ways to help people know about those treatments, choose those treatments, and engage in those treatments, the better. The beginning point of that, that key beginning point, is making a correct diagnosis.
Finally, people are curious about whether other CAT tools exist. Certainly, there are a number of CAT tools out there designed by a number of different individuals. I know that Adaptive Technologies also, and Dr. Gibbons, have been working on some other tools that we also have been working with in the VA and testing in the VA, including a screener for suicide risk.
The suicide risk tool is something that we've been working on evaluating and are excited about some of the data we have about the suicide risk tool. I think you'll be hearing more about that from me in the literature in the future
Brenner LA, Betthauser LM, Penzenik M, et al. Development and validation of computerized adaptive assessment tools for the measurement of posttraumatic stress disorder among US military veterans. JAMA Netw Open. 2021;4(7):e2115707. Published 2021 Jul 1.
Lisa A Brenner, PhD, is a Board-Certified Rehabilitation Psychologist, a Professor of Physical Medicine and Rehabilitation (PM&R), Psychiatry, and Neurology at the University of Colorado, Anschutz Medical Campus, and the Director of the Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC). She is also Vice Chair of Research for the Department of PM&R. Dr Brenner is the Past President of Division 22 (Rehabilitation Psychology) of the American Psychological Association (APA) and an APA Fellow. She serves as an Associate Editor of the Journal of Head Trauma Rehabilitation. Her primary area of research interest is traumatic brain injury, co-morbid psychiatric disorders, and negative psychiatric outcomes including suicide. Dr. Brenner has numerous peer-reviewed publications, participates on national advisory boards, and has recently co-authored a book titled: Suicide Prevention After Neurodisability: An Evidence-Informed Approach.