Priorities of Consumers, Providers, and Family Members in the Treatment of Schizophrenia

OBJECTIVE: This study explored the extent and nature of agreement on outcome and service priorities between consumers, their providers, and their family members as well as providers' and family members' awareness of consumers' priorities. METHODS: Interviews were conducted with members of 60 stakeholder sets that included a person with schizophrenia, one of his or her mental health care providers, and one of his or her family members. Each member of the set ranked seven outcomes and nine services in order of importance and rated the relative importance of each. Family members and providers also ranked the outcomes and services in the order in which they believed the consumer would rank them. Magnitude-estimation-preference-weight ratios and Kendall's rank-order correlation were used to evaluate pairwise (consumer and provider, consumer and family member, and family member and provider) and within-set agreement. RESULTS: Pairwise and within-set agreement was low. In general, no more than a third of the pairs agreed on outcome priorities, and no more than half agreed on service priorities. In about half of the 60 sets, none of the three pairs agreed on outcome priorities. Awareness of consumers' priorities was limited. Family members' and providers' estimates of consumers' outcome priorities were more similar to their own preferences than to consumers'. Low rates of agreement were also noted for providers' estimates of consumers' service priorities. Within-set agreement was lower than agreement by type of stakeholder. CONCLUSIONS: Current goal-setting in nonresearch clinical settings is generating neither consensus nor a shared understanding of consumers' priorities. Priorities vary widely among consumers, among providers, and among family members.