DIALOG and DIALOG+ - News Eoin Golden and Stefan Priebe

DIALOG “How satisfied are you with your…” mental health physical health job situation accommodation leisure activities partner/family friendships personal safety medication practical help received meetings Rating of each domain from 1-7 “Do you need additional help?”

First trial 507 patients with schizophrenia/related disorder from 6 European countries On average used 4 times over 12 months After 12 months: -improved quality of life -improved treatment satisfaction -fewer unmet needs Small effect size, higher in East London

DIALOG scale 8 Quality of life items – high internal consistency correlation with full MANSA score 0.94 covering the same factorial structure 3 treatment satisfaction items good internal consistency Each item meaningful Efficient outcome measure

The EPOS project Redesign of software Extension of intervention: DIALOG+ Randomised controlled trial to test the effectiveness of the DIALOG+ intervention

Previous software

Current software Tablet device (iPad) Touch screen Intuitive interface Easily shared between patient and clinician

4-step approach Based on solution focused therapy Understanding: why? what is working? Looking forward: best-case scenario? smallest improvement? Considering options: what can the patient do? what can the clinician do? what can others do? Agreeing on actions

EPOS trial: design Cluster randomised controlled trial DIALOG+ versus active control 6-month intervention period Outcomes assessed at baseline, 3 months, 6 months and 12 months Primary outcome: Quality of Life - MANSA

Inclusion criteria: patients Age 18-65 years Treatment in community team for at least 1M No planned discharge for the next six months Diagnosis ICD-10 F20-29 Capacity to give informed consent Mean MANSA score of <5 Sufficient command of English language 179 patients at baseline

Implementation 30% of patients never started DIALOG+ 2.6 sessions (SD=1.3) in the first 3 months 1.5 sessions (SD=1.1) in the second 3 months 4.1 sessions (SD=1.9) in total

Results Better quality of life after 3, 6 and 12 months Lower levels of general symptoms after 3, 6 and 12 months Fewer unmet needs after 3 and 6 months Better objective social situation after 12 months Lower overall treatment costs over 12 months

Other outcomes No effect on other outcomes: Treatment satisfaction (CSQ-8) Self-Efficacy (GSS) Well-being ( WEMWBS) Positive symptoms (PANSS-positive) Negative symptoms (PANSS-negative) Therapeutic relationship (STAR-Patient and STAR-Clinician)

Summary of findings Effect sizes to match costly, intensive interventions (3m SQOL: d = 0.34) Effect remains even after stopping Findings do not reflect a general appraisal across scores Cost savings

Implications DIALOG+ turns routine meetings into therapeutically effective interventions – identifying needs, discussing, and initiating change Low cost, effective intervention Generic intervention Easily implemented - no disruption to services Provides meaningful routine outcome data

Downloading DIALOG app iPad users only (future plans to develop for Android users – watch this space) Visit the following link on your iPad: https://itunes.apple.com/us/app/dialog/id914252327?ls=1&mt=8​ Or search for ‘DIALOG’ (in caps) on the App Store and look out for this icon in the results:

Customising DIALOG app Enter ‘settings’ on your iPad home screen Enter the DIALOG settings from the list of your apps on the left Set ‘Additional Help’ and ‘DIALOG+’ to off for basic DIALOG scale Activate ‘Additional Help’ for extra help question Activate ‘DIALOG+’ for full solution focused intervention

Customising DIALOG app Set these buttons to ‘on’ or ‘off’ as desired

Contact details s.priebe@qmul.ac.uk e.m.golden@qmul.ac.uk