Quality standard

Quality statement 2: Discussing treatment options

Quality statement 2: Discussing treatment options

Quality statement

Adults with a new episode of depression have a discussion with their healthcare professional about the full range of treatment options. [new 2023]

Rationale

Discussing the full range of treatment options with adults who have a new episode of depression helps support them to make an informed decision about their treatment preferences. Using shared decision making, the discussion should lead to the development of a treatment plan, with choices based on the person's clinical needs and preferences. The discussion includes the risks and benefits of each option, the expected outcomes, the number of sessions to be delivered for psychological therapies and choices around aspects of delivery. Providing information about treatment options is likely to lead to improved adherence to therapy and better outcomes. It can also help to ensure that antidepressants are not routinely offered as first-line treatment for a new episode of less severe depression unless that is the adult's preferred option.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults with a new episode of depression who have a discussion with their healthcare professional about the full range of treatment options.

Numerator – the number in the denominator who have a discussion about the full range of treatment options with their healthcare professional.

Denominator – the number of adults with a new episode of depression.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Proportion of adults with a new episode of depression who felt fully involved in decision making about their care.

Numerator – the number in the denominator who felt fully involved in decision making about their care.

Denominator – the number of adults with a new episode of depression.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from a patient survey.

The Care Quality Commission's NHS community mental health survey collects data on 3 questions for adults with depression: the extent of adults' involvement in agreeing their care, the extent to which they felt involved in making a decision about their care together with the person they saw, and whether they felt involved as much as they wanted to be in deciding what NHS talking therapies to use. NHS England's Improving Access to Psychological Therapies (IAPT) patient experience (treatment) questionnaire includes the question: 'did you feel involved in making choices about your treatment and care?' Annual results are presented at national, commissioning and provider levels.

b) Proportion of adults with a new episode of depression and a preference for treatment who were offered their preferred treatment.

Numerator – the number in the denominator who were offered their preferred treatment.

Denominator – the number of adults with a new episode of depression and a preference for their treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from a patient survey.

NHS England's Improving Access to Psychological Therapies (IAPT) patient experience (assessment) questionnaire includes the questions: 'do you prefer any of the treatments among the options available?' and 'have you been offered your preference?' Annual results are presented at national, commissioning and provider levels.

What the quality statement means for different audiences

Service providers (such as GP practices, NHS talking therapy services and NHS acute and mental health trusts) ensure that pathways (including referral pathways), service protocols and capacity are in place so that adults with a new episode of depression can express a preference for treatments. They ensure that there is capacity to enable this discussion to take place, including when adults are referred across primary and secondary care.

Healthcare professionals (such as GPs, specialist nurses and mental health professionals) discuss with adults with a new episode of depression the full range of treatment options, including choices about delivery and tailoring treatments to individual needs. They provide supporting information such as the potential benefits and harms, waiting times, expected outcomes and the number of sessions for psychological therapies. Healthcare professionals support adults with a new episode of depression in shared decision making about their treatment and recognise that the discussion may take place following referral from primary to secondary care services.

Commissioners ensure that they commission services with the capacity to ensure that adults can express a preference for treatments, and that these are available in a timely manner (particularly for adults with severe depression) so that adults have a choice of treatments. They ensure that services have local referral pathways in place so that the discussion can happen, when necessary, across primary and secondary care services. They monitor services providing treatment to ensure equity of access, provision, outcomes and experience.

Adults with a new episode of depression talk to their healthcare professional about all their options for treatment. They are given information about the full range of treatments, including the number of sessions for psychological therapies, and discuss their preferences for how treatments are delivered. They are actively involved in choosing a treatment that reflects their preferences, symptoms and other circumstances.

Source guidance

Definitions of terms used in this quality statement

Treatment options

For information about treatment options for adults with depression, see table 1 in NICE's guideline on depression in adults for less severe depression, and table 2 for more severe depression. [Adapted from NICE's guideline on depression in adults, recommendations 1.3.4, 1.5.2 and 1.6.1]

New episode of depression

A first or subsequent episode of depression. [NICE's guideline on depression in adults, definitions of depression and severity]

Equality and diversity considerations

There are risks associated with taking antidepressants in pregnancy and during breastfeeding. Therefore, when planning pregnancy, during pregnancy, postnatally or when considering breastfeeding, healthcare professionals should consult NICE's guidelines on antenatal and postnatal mental health and medicines associated with dependence or withdrawal symptoms.

Some adults may need additional support during discussions about treatment options:

  • adults with language or communication difficulties (for example, sensory or cognitive disabilities, or autism)

  • adults with acquired cognitive impairments that affect communication (for example, dementia, Parkinson's disease or traumatic brain injury)

  • adults who do not speak English.

Examples of additional support include:

  • using a method of communication appropriate for their needs (for example, using a British Sign Language interpreter, or augmentative and alternative communication)

  • using interpreters from the same cultural background

  • using language that takes into account family background and wider context.

Commissioners and providers should consider their local population and any unwarranted variation in provision of treatment between adults with depression in groups such as:

  • adults from minority ethnic backgrounds

  • lesbian, gay, bisexual and trans adults

  • adults experiencing homelessness, refugees and asylum seekers.

Healthcare professionals should recognise and address cultural and ethnic differences when developing and implementing treatment plans. This includes a faith-sensitive approach and explaining depression in a way that is meaningful to specific cultures, for example, to reduce stigma that can be associated with symptoms and diagnosis.

Adults should also be given the option to express a preference for the gender of the healthcare professional. [Adapted from NICE's guideline on depression in adults, recommendations 1.1.1, 1.2.15, 1.4.1, 1.16.5, 1.16.6, and tables 1 and 2; NICE's guideline on depression in adults with a chronic physical health problem, recommendations 1.1.3.3 to 1.1.3.5; and expert opinion]