Effectiveness and Implementation of a Clinician Decision Support System to Prevent Suicidal Behaviors

Not Applicable

Not yet recruiting

• Conditions: Suicide, Attempted; Suicide
• Interventions: Diagnostic Test: Clinician Decision Support Tool

• Registration Number: NCT05671133
• Lead Sponsor: Massachusetts General Hospital

Brief Summary

The primary aim of this project are to evaluate a comprehensive, practice-ready, and deployment-focused strategy for improving the prediction and prevention of suicide attempts among a sample of 4,000 patients presenting to an ED with a psychiatric concern. Our first aim is to evaluate the effects of providing information about risk of patient suicidal behavior to ED clinicians. We hypothesize that patients randomly assigned to have their clinician receive their risk score will have a lower rate of suicide attempts during 6-month follow-up and that this effect will be mediated by changes in clinician decision-making.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2022-12-16
• Status Verified: 2023-01
• Study First Submitted QC: 2023-01-03
• Last Update Submitted: 2023-01-03
• Study First Posted: 2023-01-04
• Last Update Posted: 2023-01-04
• Study Start: 2023-07
• Primary Completion: 2027-06
• Study Completion: 2028-06

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 4000

Inclusion Criteria

• Age 18 years or older
• Presentation to emergency psychiatry service

Exclusion Criteria

• Inability to understand study procedures and provide informed consent, such as those with gross cognitive impairment (including florid psychosis), intellectual disability, dementia, acute intoxication
• Presence of violent or extremely agitated behavior

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Experimental	Clinician Decision Support Tool	Patient's clinician is given Clinician Decision Support Tool

Primary Outcome Measures

Name	Time	Method
Suicide attempt	6-months	Suicide attempts will be measured using two methods: (a) self-report surveys and (b) documentation in the Electronic Health Record during the follow-up period. Self-report questions about suicide attempts will be those from the Self-Injurious Thoughts and Behaviors Interview (SITBI), a widely-used measure of suicidal thoughts and behaviors with strong reliability and validity and one of the measures recommended in the PhenX toolkit. We also will examine all new medical records during the 6-months following each participant's index ED visit to determine if the participant revisited the hospital due to suicide ideation or suicide attempt during the follow-up period. This approach has been used in prior studies to measure such outcomes. In our own prior work in the ED we have found high agreement between self-reports on the SITBI and the documentation of suicide attempts in electronic medical records (K=.84).

Secondary Outcome Measures

Name	Time	Method
Suicide attempt	1-month and 1-week	Secondary endpoints are suicide attempt (using the same assessment methods as the primary endpoint) within 1-month and 1-week post-randomization and will also be assessed using two sample tests of proportions.