Abstract
BACKGROUND: Major depressive disorder (MDD) is a common and debilitating cause of disability worldwide. Recently, it has been suggested that individualized goal setting may play a role in patient-centered recovery. This study aimed to survey the landscape of patient-physician communication around goal setting for MDD treatment, as well as understand whether goal setting using the SMART (specific, measurable, attainable, realistic, and time-bound) framework is associated with positive treatment indicators in MDD. METHODS: Patients in Japan (≥ 18 years of age) who self-reported a verified MDD diagnosis were eligible to complete a self-administered survey through the Personal Health Record service, a web-based smartphone app. Patients were asked about whether they communicated with physicians about treatment prospects and/or goals. A 'SMART-Goal score' tool was developed to evaluate patient goals against the five SMART criteria. Treatment satisfaction scores and scores on the Wake Forest Physician Trust Scale Short Version (TRUST) were assessed as indicators of outcomes in this study. Descriptive questions were used to explore patients' perceptions of goal setting. RESULTS: In total, 466 patients were eligible for inclusion in the analysis. The majority (70.0%) reported communicating with their physicians about treatment prospects and/or goals. These patients (Com + group) had a median (Q1, Q3) TRUST score of 70.0 (60.0, 80.0), compared with 50.0 (40.0, 70.0) in patients who reported an absence of communication (Com - group). Median (Q1, Q3) treatment satisfaction scores were 5.0 (4.0, 6.0) and 4.0 (3.0, 5.0) for the Com + and Com - groups, respectively. In high SMART-Goal scoring groups, approximately 75% of patients exceeded the overall median scores for TRUST (70.0) or treatment satisfaction (5.0) reported for the Com + group; only 25% of patients in low SMART-Goal scoring groups achieved the same in either measure. Most patients (89.3%) who set goals recommended goal setting. CONCLUSIONS: This exploratory study suggests that communication between patients and physicians regarding goal setting in MDD treatment may be associated with positive patient perceptions of treatment. High-quality SMART goal setting also appears to have positive aspects for patients with MDD, which may in turn affect treatment outcomes. Further studies are needed to confirm these initial findings. TRIAL REGISTRATION: Registered on the UMIN Clinical Trials Registry (ID: UMIN000050370) on 17 February 2023.